The "Story Behind the Curve" helps us understand why the data on heart disease is the way that it is in our community. When we understand the root causes of our community problems, we have a better chance of finding the right solutions, together.

Graham County is geographically isolated, with a small population. There is no gym, or organized physical activity for community participation. There is one primary care provider, and no specialists. There is one grocery store, and one farmer's market. Each of these limits the selection and availability of healthy choices in the community. Being central Appalachia, the food culture also impacts the healthy cooking methods that are used, as tradition doesn't lend to healthy cooking options. There are no exisiting policies or programming around healthy lifestyle, or heart disease. 

There are several lifestyle factors that can be looked at to address heart disease, such as nutrition, physical activity, food access, and access to preventative healthcare services.  We chose to focus on these concerns as one priority due to their related nature. Obesity contributes to heart disease and if we can address obesity, we can improve outcomes for heart disease, as well(Graham County CHA 2021).

Key informants were asked to identify what they believed to be contributing to the problem of heart disease and responses included, “Lack of safe spaces for pedestrians and bicycle riders,” “We don't have anything to encourage physical activity,” and “We do not have a gym accessible for people to work out” (WNCHN - Key Informant Survey, 2021).  When asked what is contributing to progress, responses included, “urgent care clinic,” and “more medical equipment” (WNCHN - Key Informant Survey, 2021). 

What's Helping? These at the positive forces are work in our community and beyond that influence this issue in our community.

• MANNA FoodBank is working with Stecoah Valley Center to organize a monthly drop off of fresh produce through a "MANNA Pop Up Market".  
•  GREAT (Graham Revitilazation Economic Action Team) is continuously working to improve access to walking trails, and healthy food choices. Currently, a grant supports food vouchers to a local organic farm for low-income individuals and families. 
• Grace Plance, A Community Table offers a weekly community meal open to everyone. 
• Robbinsville United Methodist Church Food Pantry

What's Hurting? These at the negative forces are work in our community and beyond that influence this issue in our community.

• Geographic isolation
• Lack of availability
• Culture and tradition

The partners for this Cardiovascular Disease priority include:

The following actions have been identified by our partners and community members as ideas for what can work for our community to make a difference on Cardiovascular Disease.

Actions and Approaches Identified by Our Partners These are actions and approaches that our partners think can make a difference on cardiovascular disease. 

• Collaborate with MountainWise to provide tabacco education in the schools
• Collaborate with local health care providers and GREAT on the exploration of the COACH Program

What is Currently Working in Our Community These are actions and approaches that are currently in place in our community to make a difference on cardiovascular disease.

• GREAT continues to improve local walking trails and Way Finding signage for walking downtown Robbinsville.

Evidence-Based Strategies These are actions and approaches that have been shown to make a difference on cardiovascular disease.

What Community Members Most Affected by Cardiovascular Disease Say These are the actions and approaches recommended by members of our community who are most affected by cardiovascular disease.

• Elderly ages 65+
• Obese adults
• Those with diabetes
• Those who use tobacco products

Process for Selecting Priority Strategies

During our group process, the following criteria were applied to the issues listed above to select priority health issues of focus for our community over the next three years: 
 

• Criteria 1 – Relevant – How important is this issue? (Urgency to solve problem; community concern; Focus on equity; Linked to other important issues) 
• Criteria 2 – Impactful – What will we get out of addressing this issue? (Availability of solutions/proven strategies; Builds on or enhances current work; Significant consequences of not addressing issue now) 
• Criteria 3 – Feasible – Can we adequately address this issue? (Availability of resources (staff, community partners, time, money, equipment) to address the issue; political capacity/will; Community/social acceptability; Appropriate socio-culturally; Can identify easy, short-term wins)

 
Participants used a modified Hanlon method to rate the priorities using the criteria listed above.  Then dot-voting techniques were used to narrow to the top 3 priority health issues.