Research Accomplishment Reports 2011

Health Education Leadership, KY

Vail, A., F.D. Scutchfield
Department of Human Environmental Sciences

 

Non-Technical Summary

Kentucky is near the bottom in every major health status indicator. Mortality rates from diabetes, heart disease and most cancers are among the worse in the nation. The greatest factors contributing to these above-average mortality rates are traditionally learned unhealthy behaviors concerning personal wellbeing and pervasive difficulties in accessing needed and necessary care.

Cardiovascular disease is the leading cause of death in every county of Kentucky. The most recent data from 2004 suggests that it accounted for approximately 30% of deaths in the state with 371.8 per 100,000 population. Almost 40% of hospitalizations in Kentucky are due to heart attacks, stroke or other health problems associated with cardiovascular disease. Those with cardiovascular disease-related hospitalizations spent a total of 325,795 days as inpatients in Kentucky hospitals with total charges resulting in more than $860 million.

According to the United Health Foundation's state health rankings for 2007, Kentucky ranked 50th in the nation for the number of cancer deaths. Health Education Leadership KY utilizes University partnerships of the Kentucky Cooperative Extension Service with academic health centers at the University of Kentucky in efforts to implement health education and outreach programs to address health literacy and health behaviors that are at the core of these chronic disease problems in Kentucky Communities.

The model of building teams and partnerships between the community and campus utilizes University resources and expertise to impact the health of Kentuckians. This project translates the Extension Diffusion Model to the diffusion of health innovations within the micro unit of the family in the broader contexts of community and the public health system. Multidisciplinary teams of Extension Specialists, Academic Health Center Faculty, Extension field professionals, students, and community partners will address priority health issues utilizing a logic model approach with a conceptual ecological framework identifying the family at the center of public health system. The underlying concepts are that health-related behaviors are best understood within their relational, social, and environmental contexts.

Health Education Leadership KY will create a partnership of families, communities, Extension professionals, and University researchers to design and implement programs at the local level that will change the health status of Kentuckians utilizing the Extension diffusion model to more rapidly diffuse new research findings and programs throughout Kentucky. Success will be measured in terms of pre-test, post-test of knowledge gained, behaviors changed, increased capacity of the community to address health issues, cost benefit of the intervention, and/or social and economic impact to the local communities The project will examine the effectiveness of new health behavior interventions piloted in Kentucky and diffuse effective and successful interventions through Cooperative Extension Service Family and Consumer Science Agents located in all 120 Kentucky counties.

2011 Project Description

Kentucky's Family Consumer Sciences Extension Agents reported during a needs assessment that caregiving preparation is a major issue throughout the state of Kentucky. This is in part due to chronic illness and accompanying mental health issues, as Kentucky ranks 5th in the United States for dementia risk factors, hypertension and inactivity. Comparing the Extension data collected from 120 Kentucky counties with data from the 2005 Kentucky Elder Readiness Initiative (KERI), caregiving needs to take a high priority.

In Kentucky, the Mental Healthiness Aging Initiative (MHAI),implemented in Eastern Appalachian counties examined mental health awareness among community residents. The data highlighted specific themes related to mental health and aging including the importance of emotional health and the ability to remain active and engaged. Furthermore, the importance of intergenerational activities and the value of sharing one's life story was highlighted as being necessary for good mental health as part of the management of old age.

Memory Banking is an intervention program aimed at documenting and tracking personal life stories and health histories. The intervention is focused on improving dyadic caregiver communication and is designed to produce a tangible legacy that will aid individuals to a) guide healthcare decisions and person-centered care; and b) be motivated to take responsibility for their own health. This project has developed an intervention that will support the process of caregiving preparation through the application of a shared life history project entitled: Memory Banking.

The first part of the Memory Banking study finalized the development of a five-week Memory Banking intervention series. Subsequent activities of the study and intervention will involve administration of the series to examine its feasibility and preliminary effectiveness. Thirty new patients (65+) who set up appointments at the Sander's Brown/ADC Memory Disorders Clinic will be recruited for cognitive evaluation related to Mild Cognitive Impairment (MCI) and early Alzheimer's disease (AD). Participants will be asked to identify and bring along a caregiver or potential caregiver to participate with them in the five-week Memory Banking dementia research trial to create a caregiver dyad. Thirty older adults who do not complain of memory impairment (65+) residing in the community will be recruited with the aid of Family Consumer Sciences Cooperative Extension Agents. The Community participants will also be asked identify and bring along a caregiver or potential caregiver to participate with them in the five-week Memory Banking community research trial to create a caregiver dyad. The community and dementia participants will participate in separate memory banking sessions.

In relation to preliminary intervention effectiveness, the 60 dyad pairs will be compared over two time points (pre and post test) to examine changes in mental health, perceived stress, perceived support, and quality of life. These results, will allow us to examine the intervention at a larger scale and to test a variety of methodologies to improve the versatility of the Memory Banking program.

2011 Impact

In order to support the process of caregiving preparation we propose a novel intervention focused on improving dyadic caregiver communication through an intervention entitled Memory Banking. This study is important for both older persons and for current and potential caregivers, in addition to younger generations. We believe documenting one's life story will contribute to individual well-being and mental health.

The seed funding that HEEL provides will allow us to test our novel research questions and lead us to seek national-level funding to expand our research and create a branded Memory Banking program that will help caregivers and people of all ages who face the aging process and chronic disease.

Upon being able to examine effectiveness and versatility of Memory Banking, we believe that we can sustain it by a) implementing it as Extension Curriculum/Featured Extension program; b) launching it through the eXtension Family Caregiving Community of Practice for national dissemination; and c) working with Sanders Brown Center for Aging to incorporate the intervention as a longitudinal component of their Alzheimer's disease Center.

2011 Publications

Kruger, T., Murray, D., and Zanjani, F. (2011). The mental healthiness and aging initiative: Lessons from a social marketing-informed research campaign in Kentucky. Social Marketing Quarterly, 17(3), 18-38. doi: 10.1080/15245004.2011.595537

Kruger, T., Murray, D., and Zanjani, F. (2011). Rural community members' perspectives on mental health and aging: An ecological approach to interpreting and applying focus group results. Journal of Extension, 49(2)

Zanjani, F., Kruger, T., and Murray, D. (2011). Evaluation of the mental healthiness aging initiative: Community program to promote awareness about mental health and aging issues. Community Mental Health Journal, 1-9. doi: 10.1007/s10597-011-9373-1