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Health Education Leadership, KY
Vail, A., F.D. Scutchfield
Department of Human Environmental Sciences
The United Health Foundation ranks the health status of each state annually based on a number of risk factors, including personal behaviors, community and environment, and public health policies that culminate in key health outcomes related to quality of life and longevity. In 2007, Kentucky had the seventh worst health status in the nation.
In 2008, according to the Kentucky Institute of Medicine, there are very few diseases endemic to the state. Also, Kentucky has little heavy industry that might impair one's health. However, many of the health problems in the commonwealth are due to poor lifestyle choices, which lead to otherwise preventable diseases and premature death. Kentucky is near the bottom in every major health status indicator. Mortality rates from diabetes, heart disease, and most cancers are among the worst in the nation. The greatest factors contributing to these above-average mortality rates are traditionally learned unhealthy behaviors concerning personal well-being and pervasive difficulties in accessing needed and necessary care.
The Health Education Leadership, KY initiative bridges people, resources, ideas, and actions, using the unique model of the land grant system of outreach and education combined with university-based research partnerships with the academic health centers at UK. The extension agent is the change agent for families and communities. In terms of health behaviors, agents have a great deal of influence on the families with whom they work and within the communities where they reside and work. Diffusion research traditions are rooted in rural sociology and extension work. Particular innovations from many disciplines including agriculture, medicine, public health, consumer product innovation, marketing, education, and technology have been documented by scholar Everett Rogers.
Extension research primarily focused on individual farmers and the diffusion process through individual adopter attributes. The Health Education Leadership, KY initiative focuses on applying this extension research tradition in creating a model for diffusing innovations in family health systems. The Health Education Leadership, KY initiative operational model is one of a dual diffusion system. As new pilot programs are being developed by faculty/agent/student/community teams, these programs are diffused within the Extension organizational system through agent in-services with the influence and support of extension specialists and university faculty. At the same time, they are also being diffused through family and community systems by those early agent adopters.
The project focuses on developing strategies to address unmet health needs in Kentucky. Working with university-community teams, the project will develop family focused strategies that can be piloted in local communities utilizing community participatory research techniques to inform extension programs. These pilot programs, after being tested for efficacy, will be disseminated across Kentucky.
2011 Project Description
Established programs of the Health Education Extension Leadership, KY (HEEL) project been carried out in all 120 counties of Kentucky. The majority of Kentucky is very rural, but population centers exist around the major cities Cincinnati (Northern Kentucky), Lexington, and Louisville, known as the "Golden Triangle." As with most rural states, Kentucky has many health professions shortage areas outside of its metro centers. Kentucky's health status continues to be among the worst in the nation with the United Health Foundation ranking Kentucky 44 in overall health status among the 50 states (2010). It ranks 40th in determinants (indicating that overall healthiness may improve over time according to United Health Foundation's America's Health Rankings) and 45 in health outcomes.
Extension specialists have developed or enhanced existing programs to address Kentucky's determinants of poor health status. During the three year grant period, programs were implemented in all phases of health including mental health. In efforts to reduce the burden of chronic disease, the program focused on weight management and increasing physical activity through programs such as Weight the Reality Series, Literacy, Eating, and Activity for Preschoolers (adding primary grade curriculums).
The Foundation for a Healthy Kentucky recognized LEAP (The Literacy, Eating, and Activity for Pre-School) Program as being a model program that works. Kentucky Educational Television featured the LEAP program in a Be Well Kentucky broadcast on model programs that work.
The Get Moving Kentucky, a physical activity program has been enhanced to include the evidence based Matter of Balance program focused on improving physical activity in the aging population; as well as the NIFA partnership for America on the Move (AOM). Kentucky has been able to show improvements in physical activity, at the family level, utilizing the AOM program. Families on the Move adapted the AOM materials into 6 weekly newsletters distributed to participants.
The evidence based Matter of Balance program also reduces the likely hood of falls in the aging population, reducing the costs of medical care to treat broken bones and injuries in this population.
The Kentucky Team Up! Cancer pilot in nine (9) Eastern Kentucky counties demonstrated that Extension working with public health partners could increase screening rates.
Mental health programs included Blue to You which was piloted in Western Kentucky and diffused to other parts of the state in 2010.
The Mental Health and Aging Initiative train the trainer intervention was evaluated for efficacy. Effectiveness was evaluated by examining changes in attitudes and knowledge about mental health/substance abuse and aging, from pretest to posttest and again three and six months later.
21% of Kentuckians in 2010 (rank 35) reported consuming five or more fruits and vegetables daily. 70% of Kentuckians in 2010 reported participating in physical activities, an increase from previous years indicating overall healthiness may improve with time. The number of Kentuckians reporting a change in knowledge, opinions, skills, or aspirations regarding lifestyle changes because of participating in Extension Health programs increased from 105,512 in 2008 to 196,560 in 2010. The number of Kentuckians reporting making a lifestyle change because of participating in Extension Health programs increased from 50,626 in 2008 to 103,761 in 2010.
The number of joint programs with non-Cooperative Extension organizations that focus on comprehensive health maintenance increased from 1322 programs in 2008 to 2162 programs in 2010. 61 counties participated in Weight the Reality Series with 5,348 participants. 2,036 reported losing 5% of their body weight, with 508 reporting in 2009 and 2010 maintaining the weight loss.
A total of 305 families, including 435 adults and 366 children, participated in KY's AOM Family on the Move program. Fifteen percent of participants increased their steps by at least one mile or 2000 steps.
The Matter of Balance program promotes exercise to increase strength and balance in elderly participants. In 2010 there were 45 counties that trained coaches with 7 counties implementing the program and reaching more than 80 elderly participants.
Literacy, Eating, Activity for Preschoolers and Primary school aged children reached 20,255 youth in 86 counties of Kentucky with 15,868 children increasing their level of physical activity, 13,925 demonstrating proper hand washing, and 19, 579 sampling a variety of foods which included fruits and vegetables.
5,870 Kentuckians participated in Small Steps to Health and Wealth during 2009 and 2010. In 2010, 2046 of 3617 participants reported increasing the amount of time spent doing physical activity. 1391 participants reported decreasing the amount of month expenses as a result of this program.
The Team Up Project continued until 2009. For purposes of evaluation, nine control counties were matched with the nine eastern Kentucky Counties.
The Kentucky Women's Cancer Screening Program reported that in comparison of the 2005 Pap Screening data Team Up counties on average screened 14.2% of the total of rarely or never screened compared to 10.8% in the control counties.
The goal of the Mental Healthiness in Aging Initiative was to build the capacity of the community to deal with the mental health issues of older community members. The fact that residents of the ten (10) pilot counties reported feeling significantly more able to help older adults with a potential mental illness than those not in the pilot counties indicates that the key message of MHAI was diffused in those counties.
In evaluation of the train the trainer MHAI program,findings were statistically significant and indicated enduring improvement in awareness and knowledge about mental health/substance abuse and aging.
Butler, KM, Hedgecock, S, Record, R, Derifield, S, McGinn, C, Murray, D, & Hahn, EJ. (2011) Evidence based Cessation Strategies: Rural Smokers Experiences with Tobacco. The Nursing Clinics of North America (In Press).