Partnering with churches to improve health in rural...
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PARTNERING WITH CHURCHES TO IMPROVE HEALTH IN RURAL COMMUNITIES KATHRYN JOHNSON, COMMUNITY MEDICAL CLINIC OF KERSHAW COUNTY & DIRECTOR, LIVEWELL KERSHAW COALITION SARA WILCOX, DEPARTMENT OF EXERCISE SCIENCE & DIRECTOR, PREVENTION RESEARCH CENTER, USC
Transcript of Partnering with churches to improve health in rural...
PARTNERING WITH CHURCHES TO IMPROVE HEALTH IN RURAL COMMUNITIESKATHRYN JOHNSON, COMMUNITY MEDICAL CLINIC OF KERSHAW COUNTY & DIRECTOR, LIVEWELL KERSHAW COALITION
SARA WILCOX, DEPARTMENT OF EXERCISE SCIENCE & DIRECTOR, PREVENTION RESEARCH CENTER, USC
PARTNERING WITH CHURCHES TO IMPROVE HEALTH IN RURAL COMMUNITIES
Background:
Participants will hear from two presenters on how faith-based organizations can be utilized to reach community members and improve health outcomes. Examples will be shared from two rural counties, Fairfield and Kershaw County.
From Kathryn Johnson, participants will learn how an integrated model of care is being provided at rural church locations to serve uninsured and underserved individuals that face multiple barriers to accessing care.
From Sara Wilcox, participants will understand experiences implementing an evidence-based program to promote physical activity and healthy eating in Fairfield County [Faith, Activity, and Nutrition (FAN)].
PARTNERING WITH CHURCHES TO IMPROVE HEALTH IN RURAL COMMUNITIES
Objectives:
Participants will share at least one approach for how social and economic factors can be addressed in a rural setting.
Participants will be able to see how an integrated model of care with Nurse Practitioners and Community Health Workers can be used to better manage chronic diseases resulting from obesity.
Participants will be able to describe how church environments can be modified to promote physical activity and health eating through four key strategies.
LIVEWELL KERSHAW INITIATIVE KATHRYN JOHNSON, MPH
DIRECTOR, LIVEWELL KERSHAW COALITION
KERSHAW COUNTY
Kershaw County Population of ~60,000
It can take 40 minutes to travel from the county seat, Camden, into the northeastern portion of the county.
6 out of 13 zipcodes (all rural) have much higher rates of Diabetes, Hypertension, and other chronic diseases compared to other zipcodes
No public transportation in the county
LIVEWELL KERSHAW OVERVIEW
In 2013, USC Institute for Families in Society identified the “North
Central” area in Kershaw County as a hotspot for chronic
disease and overutilization of Emergency Room
Satellite extensions of the Community Medical Clinic of Kershaw County (located in Camden) to the most rural
portions of the county (northeast)
THE PARTNERING PROCESS
Engaging Churches One-on-one conversations
with the Pastors Trust Building A way to fulfill mission
work through provided much needed care to community
Sites Buffalo Baptist Church
Cassatt Baptist Church
DeKalb Baptist Church
Refuge Baptist Church
SOCIAL DETERMINANTS OF HEALTH
How do we tackle improving health if
ONLY 20% of health outcomes are related to
access?
INTEGRATED MODEL OF CARE
Nurse Practitioner
Medical Assistant Clinical Care
Community Health Worker Social Services
MASLOW’S HIERARCHY OF NEEDS
Making sure basic needs are met
before moving up the pyramid.
Cannot tackle obesity in its entirety until
basic needs are met.
RESULTS (MAY 1, 2014- JULY 31, 2017)
Economic Impact: 24-25% reduction in inpatient
hospitalizations and emergency room utilization among cohort
$7,714 saved for every inpatient hospitalization avoided with Care Coordination visits
Number of individuals served: 2,471 patients served
4,749 encounters
608 connected to a medical home
ITERATIVE PROCESS
Rotating schedule and published materials on days of availability at each church
Using continuous improvement to drive decision making in satellite availability
Pair with other events to combat low volume
Focus groups
FOOD FOR THOUGHT
Providing a meal and speaker prior to Wednesday night church services
Share available resources in community
Open to congregation and community members
Open forum for feedback
OUR COMMUNITY FOOTPRINT
“I don’t mind being seen at a church. I will go where Vicki (Nurse
Practitioner) goes, no other doctor has ever
taken the time to really listen to my health problems.”
INCREASING AWARENESS OF EXISTING BARRIERS
EQUITY BUS TOUR
Let’s take a look at a bus ride…
Presenter
Presentation Notes
https://www.youtube.com/watch?v=_YwAQ7fa-FQ
SUMMARY
Relationships with faith-based organizations critical to population health improvement in rural areas
Results demonstrated
Maslow’s Hierarchy of Needs Next steps
Blueprint for Kershaw County moving forward
Kathryn Johnson, MPHLiveWell Kershaw Coalition Director
Presenter
Presentation Notes
https://www.youtube.com/watch?v=_YwAQ7fa-FQ
FAITH, ACTIVITY, AND NUTRITION IN FAIRFIELD COUNTYSARA WILCOX, PHDDEPARTMENT OF EXERCISE SCIENCE & PREVENTION RESEARCH CENTER, ARNOLD SCHOOL OF PUBLIC HEALTH, USC
PRESENTATION OVERVIEW
Description of the Faith, Activity, & Nutrition (FAN) program
Partnership with Fairfield County to conduct a dissemination & implementation (D&I) study of FAN
Results: Reach, Adoption, Effectiveness, Implementation
Overview of FAN D&I Intervention
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“Beloved, I pray that you may prosper in all
things and be in health, just as your
soul prospers.”III John 1:2
Presenter
Presentation Notes
A holistic view of health is embraced in the Bible and in other religious writings. If you attend a church in the south, you quickly see that we enjoy our fried chicken, mac & cheese, and multiple starchy sides!
PRIMARY GOAL OF FAN
Help create a healthy church environment for physical activity (PA) & healthy eating (HE) PA: 150+ minutes/week, moderate-intensity
HE: INCREASE fruits, vegetables, whole grains
DECREASE fat, sodium
Focus on 4 primary strategies to reach all members Guided by Cohen’s Structural Model of Health Behavior
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Source: Cohen et al., 2000, Prev Med
Presenter
Presentation Notes
The program that we will tell you about today - Faith, Activity, and Nutrition – or FAN - was designed to help churches create healthy church environments for physical activity and healthy eating. The program recommends that churches promote physical activity and healthy eating targets that are consistent with federal guidelines of accumulating at least 150 minutes per week in moderate-intensity physical activity and eating a diet high in fruits, vegetables, and whole grains and low in fat, especially saturated and trans fats, and sodium FAN trains and supports churches to use 4 main strategies that are designed to expose all members to this healthy environment. But FAN is not a rigid, prescriptive program but rather, is very flexible to meet the needs of very diverse churches -- there are many ways a church could provide activities for each of the strategies.
PROMOTE HEALTHY CHURCH ENVIRONMENT
Increase opportunities & programs
Create healthy church guidelines (policies)
Engage, support pastor
Get the message out27
Presenter
Presentation Notes
The next slides will describe each of the four strategy used in FAN, and I’ll provide some examples of what churches in our conference are planning or have started. Let’s start with the 1st strategy which is for churches to increase opportunities & programs for physical activity and healthy eating.
COMMUNITY HEALTH ADVISORS DELIVERED PROGRAM
Resident & member of Fairfield County church
Training Pre-training self-paced modules
(Adobe Presenter)
In-person training (USC staff)
Post-training self-paced modules (Adobe Presenter)
Quarterly booster calls28
Community Health Advisor, Ms. Cheryl Goodwin, Leading a FAN training in Fairfield County
Community Health Advisor, Ms. Bessie Gladden, Leading an active break
Presenter
Presentation Notes
In this program, community health advisors deliver all components of the program to the churches. We identified lay members from local churches who were trained as community health advisors to deliver the training and technical assistance to churches in their District. The community health advisors begin their training by completing self-paced modules, developed in Adobe Presenter, before the in-person training. These modules provide a general background of PA and HE and outline their roles and responsibilities. They then attend a full-day training at USC. They learn how to lead the church committee trainings, and they also experience in their training the actual training they will deliver so they can see it modeled. After the in-person training they complete additional self-paced modules that focus more on delivering the technical assistance calls to churches and using our online database to enter call contacts. Then, after they deliver the training to churches, USC holds quarterly booster calls with the community health advisors to address common challenges that come up on the TA calls to churches.
ASSESSMENT & PLANNING PROCESS
Assess current activities (for the 4 strategies)
Select ways to add, enhance, expand
Interactive workbook with ideas & resources
Begin FAN program plan29
Presenter
Presentation Notes
Throughout the training, churches are led through an assessment and planning process that is guided by an interactive workgroup – the Assessment & Planning Guide. For each of the 4 strategies, the church committee assesses what, if anything, they are currently doing and then select ways to add, enhance, or expand activities. Apart from a few core activities that we ask ALL churches to do, such as sharing the bulletin inserts, the church really decides what they plan to do and what they think will be best suited to their congregation. This planning and brainstorming in the training allows the church committee to begin to formulate their FAN program plan. The FAN program plan is a document where the church outlines, for each of the 4 FAN strategies, what activities they plan to put into place in their church for PA and HE.
WHAT FAN ENTAILS FOR CHURCHES
1. Church creates FANcommittee (3-5 people)
2. Committee attendsin-person training
• Active breaks
• Healthy lunch & food demo/tasting
• Resources
3. Church submits FANProgram Plan
4. Church holds kick-off event
5. Church committee meets regularly to plan activities
6. Church receives 12 brief monthly calls to support program implementation
• FAN coordinator: 8 calls
• Pastor: 4 calls
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CHA leading an active break at a FAN church committee training
Presenter
Presentation Notes
Now that you have an overview of the four strategies of FAN, let me walk you through the program from the perspective of the church. First, the church creates a FAN committee of 3-5 people. The committee must include the FAN coordinator. Other strongly encouraged members include the pastor, cooks or kitchen staff, youth directors, and members who are champions for PA/HE The committee then attends a full-day training led by the CHA where they learn about the importance of PA and HE and plan activities for each of the 4 strategies I outlined few slides ago. The training includes active breaks to demonstrate how they could be incorporated into meetings and events, a food demonstration and tasting, as well as a lunch that is consistent with FAN goals. During the training, the church begins a FAN Program Plan and later submits the plan for review and comment. I’ll come back to that in a moment. After training, the church is encouraged to hold a kick-off event to let the members know about FAN and its goals and to build excitement for it. Churches have been very creative here – for example, one of the participating churches performed a skit for members that beautifully embraced the main goals of FAN, connected FAN to scripture and to health needs of the community and congregation, and also poked at, in a light hearted way, at potential misconceptions and resistance to change. We strongly recommend that the committee meets regularly – ideally monthly - to plan FAN activities. We are seeing that churches that have regular committee meetings are more likely to be implementing the 4 strategies, so we believe this is quite important. And finally, the CHA calls the FAN coordinator and pastor, on a rotating system, every month for 12 months and receive technical assistance in putting the program into place. These brief calls help us to learn about both challenges and successes.
FAN IN FAIRFIELD COUNTY (D&I STUDY)
Fairfield County Population of ~23,000
59% African American
15% with BA or higher
21% below poverty level
Rural & medically underserved
One of the DHEC priority counties
County Health Ranking: 38/46
EVALUATION: RE-AIM FRAMEWORK
Useful for understanding the public health impact of health promotion programs
Greater focus on external validity
Helps to translate research into practice – more “real world” application Commonly used framework for D&I
research, including in PA area
Reach
Efficacy / Effectiveness
Adoption
Implementation
Maintenance
For more information: www.re-aim.org/
Presenter
Presentation Notes
RE-AIM is commonly used in the PA literature
COUNTYWIDE ADOPTION & REACH
Results not available for website
Presenter
Presentation Notes
Fairfield County – DHEC targets Fairfield Community Coordinating Council (advisory committee) Not an easy process! 7 mo recruitment process: 604 mailings 694 phone calls 307 emails 183 in-person visits County
CHARACTERISTICS OF ADOPTING VS. NON-ADOPTING CHURCHES
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Results not available for website
Presenter
Presentation Notes
For denomination, I’m just showing the two most frequent TRUST, relationship
EFFECTIVENESS
Administered anonymous surveys after worship service between June and October of 2016 8-12 mos after training of early
churches
35 early churches (832 members)
19 delayed churches (504 members)
Data collectors also did a church & neighborhood checklist
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SELECTED SAMPLE CHARACTERISTICS
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Results not available for website
EFFECTIVENESS: CHURCH ENVIRONMENT
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Results not available for website
EFFECTIVENESS: SELF-EFFICACY (CONFIDENCE)
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Results not available for website
EFFECTIVENESS: FRUIT & VEGETABLE INTAKE
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Results not available for website
EFFECTIVENESS: PHYSICAL ACTIVITY
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Results not available for website
IMPLEMENTATION RESULTS
Results not available for website
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EXAMPLES OF WHAT CHURCHES ARE DOING WITH FAN
Changed menus to include baked chicken
Added fruits and vegetables to meals & snacks
Planted garden & fruit trees
Served fruit & yogurt parfaits for breakfast
PA & healthy snacks in VBS
Gave each member a pedometer & log and started a successful church challenge
Included stretches & movement at every worship service
5th Sundays = movement
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Bible Light Holiness’ seasonal garden
SHARING FINDINGS
Church-specific reports
Infographic Companion word document
Pursuing sharing with elected officials & other stakeholders
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CHURCH SPOTLIGHTS & UPCOMING TRAINING OPPORTUNITY
Visit our website to: See Church Spotlights from FAN
Complete an interest form for a Summer/Fall 2018 training
http://prevention.sph.sc.edu/projects/fanumc.htm
Please stop by our table to get a handout on the training opportunity!
A BIG THANK YOU TO…..
Mr. Vernon Kennedy & Ms. Cheryl Goodwin, Fairfield Behavioral Health Services (FBHS)
Fairfield Community Coordinating Center (FCCC)
Community Health Advisors: Ms. Cheryl Goodwin & Ms. Bessie Gladden
Pastor Health Advisors: Rev. Henry Spann, Jr. & Rev. Ricky Gibson
Fairfield County School District
Faculty, staff, & students at USC & Clemson
Participating churches
This project is supported by Cooperative Agreement Number U48DP005000 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.
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