Optimising nutrition for the prevention of cardiovascular disease through knowledge translation with rural communities

Cardiovascular disease contributes to substantial premature mortality worldwide, with disproportionate impacts for rural communities. While rural residence is associated with greater wellbeing, rural populations experience poorer health outcomes than those of major cities. Improving nutrition for rural Australians is an important research focus, as dietary modifications can positively impact cardiovascular health. There are numerous guidelines to direct clinical practice; however, limited investigations of how to use these specifically in rural contexts. This doctoral research presents four studies and two systematic reviews, to answer the research question: how can nutrition related outcomes be improved for people who are at risk of, or living with cardiovascular disease in rural and regional Australia? This is the first body of work to focus on nutrition, cardiovascular health and rural communities, through comprehensive knowledge translation informed by the knowledge to action cycle. A range of qualitative and quantitative methods, guided by a theoretical underpinning of pragmatism, were used to address the complex research question. This thesis initially investigates the implementation of a telehealth nutrition intervention, with findings informing the research question for a qualitative study of rural health professional's perceptions of telehealth. Existing literature is synthesised, through systematic reviews of nutrition interventions for cardiovascular disease prevention, set in (i) rural communities and (ii) cardiac rehabilitation. Results from a survey of nutrition care in cardiac rehabilitation are presented, and the impact of upskilling health professionals in patient-centred behaviour change techniques is reported. Knowledge gained from these preceding components is used to develop an evidence-based action plan specific to a rural Australian context. The action plan is presented as an evaluation protocol for Hearty Habits, an intervention to upskill cardiac rehabilitation health professionals in nutrition related behaviour change. Collectively, findings provide foundational knowledge to address the question of how nutrition related outcomes can be improved for people at risk of and living with cardiovascular disease in rural communities.