Rural Women's Health Conference
Summary Report
Summary Report (PDF File, 1.82 Mb)
August 13 -15, 2007
Omni Shoreham Hotel, Washington DC |
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Workshops, Part II
Identifying and Addressing Depression During and After
Pregnancy Among Rural Georgia Women
This presentation summarized the findings of a study
on depression in expecting and new mothers. Sandra
Pittman, Ph.D., Director of the Prenatal Center at the
Medical College of Georgia, began by noting that the
study was conducted through the Enterprise Community
Healthy Start program in rural Georgia. The learning
objectives included:
- Understand process components of identifying
depression during and after pregnancy
- Consider the incidence of positive depression
scores pre- and post-natally among a population
of rural women
- Describe other considerations necessary when
women screen positive for depression
- List implications and strategies for practice in
addressing prenatal depression
- List implications and strategies for community
education in addressing prenatal depression
- Discuss implications for research in addressing
prenatal depression
Dr. Pittman explained that the program uses the Beck
Depression Index and the Edinburgh Postnatal Depression
Scale for depression screening. In many cases, they cannot
contact women by phone but can mail a letter with
information on the program and prenatal depression. She
noted that face-to-face screening is more effective because
the tool can be scored right away and discussed with the client. With mail screening, there are always concerns
about literacy level.
Dr. Pittman also noted that with scoring face-to-face, one
issue is how to follow-up with the client. She said they
look for all types of intervention possibilities. She noted
that oftentimes, the client does not want to go into care
or into counseling, but sometimes, a support group is
okay. She said they have numerous spaces arranged for
counseling to help with the issue of stigma.
Dr. Pittman reported that the results of screening included
enrolling 397 clients between 2004 and 2006. There were
111 clients in the program 3 months postpartum who had
a positive depression screen pre-natally. She said of those
clients, 18 women accepted the intervention, and 66.7
percent became negative for depression. She noted that
what you see is what you expect—the earlier you identify
depression and the earlier the woman accepts services, the
greater the number that will move from a positive to a
negative depression score.
Dr. Pittman described how Enterprise Community
Healthy Start has learned several lessons from this study.
She reported that one important fact is that depression
screening helps identify women who have severe mental
illness. Another conclusion is that group and individual
strategies may be helpful in meeting the needs of women
resistant to appointment keeping. In addition, enlisting
other community agencies will broaden community
awareness. She concluded by stating that additional
strategies for overcoming barriers to access to mental
health services must be sought and evaluated.
Using Videoconferencing
Technology to Effectively Train
Remotely Located Community
Health Promotion Staff
This presentation highlighted a health training program
that is conducted via videoconferencing. Litia Garrison,
B.S., Health Educator for the WISEWOMAN and WISE
At Every Size programs at the Southeast Alaska Regional
Health Consortium (SEARHC), began by explaining
that SEARHC is a health organization governed by
representatives from 18 communities. She reported that
the clinics serve 12,500 Native people and another 6,000
non-Natives in rural areas with minimal access to health
services. She said the service communities are spread
throughout the southeastern Alaska panhandle over a
distance of approximately 350 miles from the north to
the south end. She noted that most communities are not
connected by roads. Instead, transportation is mostly by
boats and planes.
Ms. Garrison explained that SEARHC uses
videoconferencing for business meetings, telemedicine,
telepharmacy, telebehavioral encounters, continuing
education credits, staff training, lab procedure training,
and family visits. She also noted that when people in
tightly knit communities come to Sitka for a hospital
stay, videoconferencing allows them to connect with their
families.
Ms. Garrison went on to explain that in order to enhance
their usage of the media, SEARHC sponsored a 4-day
videoconferencing training session. She said staff learned
numerous things during the training, including the
benefits of using a document camera to share information
right on the screen that they typically would have had
to send in some other way to the remote sites. Like with
theater, Ms. Garrison explained, creating an optimum set is a key to success. Good eye contact, clear sight lines, good lighting, access to tools and materials, good backdrops, and
the presenter's appearance all need to be considered.
Ms. Garrison said the group also learned about differences
between live videoconferencing and traditional classrooms.
Live videoconferencing is similar to live TV and very
different from classroom instruction. Coordinating the
teaching of those onsite and at remote locations takes
practice and planning. She said they learned about the
importance of developing involvement objectives, like
knowing how often you will include your learners, how
you will do that, when you will do it, and how many
times they will interact. The minimum standard to
strive for is 30 percent interaction time during a live
videoconferencing event. Even better, you should strive to
engage learners among remote sites, not just from the near
side to the far side.
Ms. Garrison concluded by noting that while there are
limitations, videoconferencing allows for a near hands-on
experience and helps connect people across great distances.
She said in Sitka, they could not plan a training session
on any single day and expect that people from all of the
State's remote communities would be able to make it on
that day. However, videoconferencing enables them to
schedule regular trainings and connect with people on a
consistent basis.
Improving Migrant Women's
Access to Early Detection
Services Through Effective
Partnerships in a Frontier State
This presentation highlighted a program that uses
partnerships to improve the health of rural and migrant
women, including increasing early detection for breast cancer. It was presented by Carol Peterson, M.S., RN,
National Rural/Frontier Women's Health Coordinating
Center Director and Health Promotion/Disease
Prevention Specialist, Wyoming Health Council; Cathy
Florian, Director, Wyoming Migrant Health Program;
and Mandy Hobbs, RN, Women's Wellness Coordinator,
Wyoming Migrant Health Program.
Ms. Peterson opened the session by describing how
providing health services in a large, rural State like
Wyoming presents multiple challenges. With 515,000
residents, Wyoming is very sparsely populated. Seventeen
(17) of the State's 23 counties are classified as frontier. It is
also fairly homogeneous—91 percent of the population is
white.
Ms. Peterson, Ms. Florian, and Ms. Hobbs explained
that the Wyoming Health Council (WHC) works to
address the health-related needs of low-income residents.
Formed in 1990, WHC is the coordinating agency for
the State's Title X Family Planning Program. Partnering
with other organizations is a critical part of providing
services in rural areas because it can reduce duplication
of services. They went on to explain that since WHC is a
nonprofit organization, as opposed to a public entity, it is
not weighed down by bureaucratic issues. This allows for
more rapid implementation of programs and the ability to
respond quickly to changing priorities. Another important
aspect of partnering is that programs can pool resources
and complement strengths and weaknesses.
The presenters described how the Wyoming Migrant
Health Program (WMHP) serves the Big Horn Basin area,
which includes four counties—Park, Big Horn, Washakie,
and Fremont. They stated that the goal of the program
is to improve the health status of migrant and seasonal
farm workers and their families through the assurance of
high-quality primary and preventive care. WMHP also administers the Women's Wellness program. This program
provides navigation for wellness services for women who
are uninsured or cannot afford to pay for annual breast
and cervical cancer screening. The program also provides
education on self breast exams, either on an individual or a
group basis.
The presenters explained how the program grew
significantly during the first 2 years in terms of both
staff and clients. A secretary was added to take care of
paperwork, schedule appointments, make reminder calls,
and communicate with the State Health Department. An
outreach worker was also hired. They concluded by noting
that in year 2, the program conducted 559 educational
encounters and 264 clinical breast exams, of which 18
were abnormal. They also provided 199 mammograms, of
which 14 were abnormal.
A Survey of Rural Women's
Health Literacy and Sources of
Health Information
This workshop offered strategies for improving
community health literacy. Barbara Disckind, Senior
Writer at the U.S. Department of Health and Human
Services Office on Women's Health, began the session
with a definition of health literacy—the ability to obtain,
process, and understand health and medical information.
She noted that it is different from regular literacy. Many
highly literate people have low health literacy. Health
literacy is affected by culture, knowledge, and the clarity
with which health information is communicated.
Ms. Disckind went on to note the importance of health
literacy, which can directly effect people's medical
treatment. Many underserved people (e.g., elderly, poor,
low education, minority, and limited English speakers) may have their health care suffer in quality due to health
literacy issues. In 2003, the National Assessment of Adult
Health Literacy found that 90 million Americans had
either basic or below-basic levels of health literacy.
Ms. Disckind then offered several strategies for improving
health literacy, including the use of plain language and
the teach-back method. She explained that the teachback
method is a non-judgmental way of having patients
repeat instructions to make sure they understand the
health information given to them. She explained that
plain language is a tool to remove jargon from health
information. It is not "dumbing down"the information or
an insult to patients, but a helpful tool in improving health
literacy.
Next, Jennifer Peters, Coordinator for Community
Health Promotion at the University of Arizona, Mel and
Enid Zuckerman College of Public Health, Rural Health
Office, outlined four practical strategies to improve
health literacy. First, improve the usability of health
information, making sure the contents are appropriate
and easily understood. Second, improve the usability of
health services like forms and instructions. Third, improve
the accessibility of healthcare environments through clear
signs and directions. Lastly, improve accessibility to quality
health information and educators.
Ms. Peters went on to explain how health literacy issues
lead to low social empowerment, low self-efficacy, poor
health outcomes, and an increase in money spent. She
said health literacy should be viewed as a learned behavior.
Improving health literacy in a community involves
improving the environment and resources to assist
community members in supporting and helping each
other.
Ms. Peters outlined four types of literacy—fundamental,
scientific, civic, and cultural. She explained that civic literacy is the ability to recognize, process, and understand
media sources and quality; where to access media; and
how to advocate for causes. The media often sends mixed
health messages. A person with low civic literacy would
have trouble interpreting the data, which leads to low
health literacy. She concluded by stating that because of
the high prevalence of TV as a health information source,
we need to increase people's ability to discern quality
information.
Gender-Specific, Culturally
Competent Recovery Services
for Rural Women
This presentation highlighted an innovative program
that offers gender-appropriate services for substance
abuse treatment and recovery. Niki Miller, M.S., CPS,
Executive Director of the New Hampshire Taskforce
on Women & Recovery and Adjunct Faculty at the
Springfield College School of Human Services, began by
noting that 92 percent of women in need of alcohol or
drug treatment do not receive it. Ms. Miller said that you
cannot send someone away for 30 days and then expect
them to come back and be cured. For example, you would
not send someone with diabetes away for 30 days and
expect them to be healed. She explained that women heal
within the context of relationships, communities, and
families.
Ms. Miller then described the New Hampshire Taskforce
on Women & Recovery, which is a small, nonprofit
organization dedicated to improving the lives of at risk
and recovering women, families, and girls through
collaboration, education, empowerment, and advocacy. It
was formed by a group who conducted a statewide needs
assessment and made a report to policymakers. She noted
that instead of just walking away from the report, the
group formed an advocacy taskforce.
Ms. Miller discussed some of the findings from the needs assessment.
One finding was that women who had experienced more than five
treatments were told they were treatment resistant. She explained
that the treatment system is failing women and that there is also an
incredibly high rate of trauma among women in treatment. She noted
one alarming study by Feletti and Anda, which found that 78 percent of
female IV drug users experienced 4 or more types of childhood trauma,
whereas only 0.5 percent of non-traumatized women use IV drugs. Ms.
Miller explained there is a clear cycle of sexual and violent victimization
and addiction.
Ms. Miller stated that the New Hampshire Taskforce on Women &
Recovery developed five types of services:
- Corrections services—workers go into the prison system and
deliver interventions. Ms. Miller noted there is a skyrocketing
rate of incarceration of women that is driven by substance
abuse.
- Telephone "warmline"and linkage services—both providers
and women can call for help and information. Ms. Miller noted
that the majority of these services are provided by volunteers.
- Professional and public education
- Women's Leadership Training Initiative (WLTI)—an
initiative that spans mental health, substance abuse, and
domestic violence. Ms. Miller noted WLTI is funded by the
Substance Abuse and Mental Health Services Administration's
Center for Mental Health Services and Center for Substance
Abuse Treatment.
- Ensuring the voice of recovering women and families is at
every table
In closing, Ms. Miller noted that through this effort, the New
Hampshire taskforce has learned several things that they did not know
5 years ago. In the past, women have been labeled treatment resistant,
but the reality is that the treatment was woman resistant. She explained
that the treatment did not address child care, history of trauma, and
other important issues. No system is capable of healing every recovering
woman, but every recovering woman has a role in healing the system.
Substance Abuse Treatment
for Women in Rural Indiana: A
Costly Gender Gap
This presentation summarized the findings of a study on
the gender gap between substance abuse treatment services
for men versus services for women in rural Indiana. Ruth
Case, B.S., Performance Improvement Coordinator at the
Affiliated Service Providers of Indiana (ASPIN), began
by providing an overview of ASPIN, which is located in
Indiana. ASPIN is a network of 13 community mental
health centers and addiction providers that deliver services
to 74 of Indiana's 92 counties.
Ms. Case noted that there
are 45 federally designated
rural counties in Indiana,
and many other counties are
very rural, although they have
not officially received that
designation.
Ms. Case explained that ASPIN
conducted a needs assessment
and identified that women in
need of addiction treatment
were a significantly underserved
population. She said one of the first things ASPIN did
was look at the data and analyze the differences between
women and men in substance abuse treatment. They
found that women represented only 35 percent of those
served, despite data indicating that addiction is an equal
opportunity disease. Yet, the total cost of serving women
was 47 percent of the total overall cost for substance abuse
services. They also found that women in treatment have
a lower average annual household income than men in
treatment, yet women have a higher average number of
dependents in their households. Of individuals desiring employment, the unemployment rate for women was much higher. Ms. Case explained that this information
means that women who need treatment typically need
more services at higher costs, yet they have less money to
pay for them.
Ms. Case then discussed the numerous barriers to
treatment for women. She noted that the financial barrier
is tremendous. If you only have enough money to buy
groceries for your children, you are going to spend the
money on that, not on a weekly treatment session.
Transportation and child care are also significant barriers.
She went on to explain that there
are also barriers to treatment in
the legal system. In many cases,
women are more likely to be sent
to jail than to be referred to a
court ordered treatment diversion
program.
Ms. Case concluded the session
by outlining several strategies
ASPIN identified to effect change.
She said the first key is to reduce
barriers to treatment. A number of
providers who work directly with
the courts showed them that the number of referrals were
higher for men than for women. Ms. Case noted that this
information was an eye-opener to the courts. Ms. Case
then described additional strategies that included securing
funding for childcare, developing women-only treatment
groups, offering combined treatment, and providing
supplemental educational programs. She said securing
financial support is also a key strategy. One solution is
to look at how current funding can be adjusted to target
women. Ms. Case said ASPIN also did a lot of work with
the court system to talk about the cost of incarcerating women versus putting them in a treatment program.
She explained that another way to consider the financial
burden involved is to look at costs now versus hidden
costs down the road that will be incurred if women do
not receive treatment. She went on to explain the hidden
costs of not providing treatment—which include judicial
costs, incarceration, child welfare, and child treatment
costs. For example, each child afflicted with Fetal Alcohol
Syndrome will cost $1.4 million over his or her lifetime in
institutional and medical costs.
Taking Control: Women and
Their Options in Treating
Premenstrual Syndrome and
Menopause
This presentation offered a
summary of options for dealing
with menopause. Carol Roberts,
M.D., President and Medical
Director of Wellness Works,
began by noting that menopause
occurs in stages. In their
40s, most women experience
perimenopause, during which
ovulation is intermittent.
Dr. Roberts explained that
menopause occurs when menses
cease, which for most women
is in their 50s. As women
enter their 60s, the process continues with a decline in
the production of all hormones. There are a range of
symptoms associated with the various stages of menopause,
many of which overlap. These include insomnia, mood
swings, poor concentration, and memory loss. In
particular, during menopause a rise in cholesterol, weight gain, and bone loss can occur. She noted the greatest bone loss occurs in the first 5 years of menopause.
Dr. Roberts questioned, if menopause is a natural process,
why is it necessary to treat it? She said over the centuries,
there have been various approaches to addressing the
symptoms of menopause. These have included committing
women to insane asylums, divorce, and herbal treatments.
She said in 1950, Premarin, the first form of estrogen
replacement therapy (ERT), also known as hormone
replacement therapy (HRT), was introduced.
Dr. Roberts noted that following the introduction of
ERT, the incidence of endometrial, uterine, and breast
cancer increased significantly. In the 1970s, progestins
were invented and used to
prevent uterine cancer, when
combined with Premarin. She
said in 2002, questions were
raised about the safety of HRT
(progestins and Premarin).
However, it was also reported
that HRT can prevent heart
disease. Currently, many
women are unsure of what is
the best approach for treatment
of the symptoms of menopause.
Dr. Roberts concluded by
noting that bioidentical
hormones are an alternative
to HRT for the treatment of menopausal symptoms.
In addition, she noted that they are available over-thecounter,
which is an indication of their safety.
Women's Bone Health: Issues
Through the Lifespan
This workshop included presentations on three topics:
- Secondary osteoporosis
- The female athlete triad
- Fracture care.
Secondary Osteoporosis
Kimberly Templeton, M.D., Associate Professor of
Orthopaedic Surgery and Health Policy and Management
at the University of Kansas Medical Center, began her
presentation on the first topic by noting that peak bone
mass occurs in females between 11 and 14 years of age.
She said bone mass is relatively constant until mid-life,
after which, women undergo two phases of involutional
bone loss. Dr. Templeton explained that while bone
density is used to define osteoporosis, bone quality is also
an issue. In fact, she said, there are multiple issues involved
in bone health. These include genetic influences, exposure
to hormones, and lifestyle (e.g., diet, exercise, smoking,
and alcohol consumption). Dr. Templeton went on to
explain that there are also various medical conditions and
medications that can increase the risk of osteoporosis.
Medical conditions include insulin-dependent diabetes,
malabsorption syndromes, hyperparathyroidism,
hypogonadism, rheumatoid arthritis, and inflammatory
bowel disease. Various medications associated with
reduced bone mass in adults include anticonvulsants,
cytotoxic drugs, glucocorticoids and adrenocorticotropin,
gonadotropin, and immunosuppressants.
Dr. Templeton noted that oral contraceptives have also
been associated with loss of bone mass. However, there
is conflicting data and many variables including differing
strength. She explained that there have been many studies
done relating to this topic. While the findings are mixed, it is most likely that use of oral contraceptives has an impact
on bone mass. She said breast cancer also is a proposed risk
factor for osteoporosis, which can be related to premature
ovarian failure, direct effects of chemotherapeutic agents,
direct effects of breast cancer, or the effect of anti-estrogen
hormonal agents.
Dr. Templeton concluded the first part of the presentation
by noting that there are many additional factors that affect
bone health. These include lifestyle and other conditions
and/or their treatment. She said these conditions effect
bones either through impact on sex hormones or other
mechanisms.
The Female Athlete Triad
Sharon Hame, M.D., Associate Clinical Professor at the
University of California, Los Angeles, Department of
Orthopaedic Surgery, began by explaining that the Female
Athlete Triad (FAT) is made up of three conditions: (1)
disordered eating, (2) amenorrhea, and (3) osteoporosis.
She said these three components do not need to occur
simultaneously. She went on to explain that while the
prevalence of FAT is unknown, major variables are age,
sport, and ethnicity. She also noted important factors
include striving for low body weight and participation in
an activity where appearance is judged.
Dr. Hame explained that eating disorders are a wide
spectrum of harmful and often ineffective eating
behaviors used in attempts to lose weight or achieve a lean
appearance. Behaviors associated with disordered eating
include binging, purging, caloric restriction, excessive
exercise, and use of diuretics, laxatives, and diet pills.
Dr. Hame reported that an estimated 3 percent of young
women suffer from disordered eating—10 to 62 percent
of females athletes suffer from it. With female athletes,
the risk factors include the perception that thinness can improve performance, as well as pressure from coaches, parents, and judges.
Dr. Hame went on to explain that inadequate nutrition
accompanied by excessive exercise can result in the ovaries
decreasing production of estrogen, leading to amenorrhea,
which can lead to bone loss. Amenorrhea is defined as the
lack of menses for 3 or more consecutive months after
menarche begins. Dr. Hame reported that amenorrhea
occurs in 2 to 5 percent of the general female population
and in 15 to 66 percent of female athletes.
Dr. Hame concluded the second part of the presentation
by stating that FAT is treatable. Key aspects of treatment
include athletic participation, positive energy balance,
healthy weight goals, frequent visits with health care
professionals, and written contracts. She emphasized that
in order to treat disordered eating, a multidisciplinary
team approach is often used including a physician,
psychologist, nutritionist, athletic trainer, coaches, and
parents.
Breaking Tradition: A New Look at
Fracture Care
Laura Tosi, M.D., from the Division of Pediatric
Orthopaedic Surgery at the Children's National Medical
Center in Washington, DC, began the third part of the
presentation by asserting that too much focus and public
attention has been directed toward osteoporosis. She
explained that while osteoporosis is a serious condition,
fracture risk is a much more comprehensive way of
assessing an individual's bone health and determining the
likelihood of future fractures.
Dr. Tosi reported that each year in the United States there
are 1.5 million fractures. Fractures can have significant
consequences. For patients with hip fractures, 6.3 percent die while in the hospital. Of the 93.7 percent that survive, up to one-third dies within a year. Of those who live
beyond a year, half of those returning home need help
with daily activities. She noted that the estimated annual
cost of treating fragility fractures is $12-$18 billion.
Dr. Tosi stated that traditionally, calculations on fracture
risk have been based on the World Health Organization's
(WHO) definition of osteoporosis. However, this has
been revised and the new approach considers age, previous
history of fracture over age 45, bone mass density (BMD),
low body mass index (BMI), family history of hip fracture,
current cigarette smoking, high alcohol intake, and
previous steroid exposure. This new approach is based on
evidence that prior fractures are a risk factor for future
fractures—the risk increases 1.5-9.5-fold following the
initial fracture. She noted that a history of fragility fracture
is more predictive of future fracture than bone density.
Dr. Tosi concluded by stating that other important
considerations with fracture risk are the rapidly expanding
population of individuals with secondary osteoporosis and
the fact that the majority of Americans are not receiving
adequate levels of Vitamin D, which plays a critical role
in calcium absorption. According to the Third National
Health and Nutrition Survey, over 70 percent of women
ages 51-70 were estimated to not be meeting adequate
intake guidelines for Vitamin D based on daily intake
from diet and supplements.
New Leaf Choices for Healthy
Living
This workshop highlighted a weight loss and healthy living
behavior change program for rural women in Alabama.
Jessica Hardy, M.P.H., B.S.N., Director of the Alabama
Office of Women's Health and Emergency Preparedness and Nurse Coordinator at the Alabama Department of
Public Health, began by reporting that Alabama ranks
second-highest in the United States for obesity, with 26-
30 percent of the population defined as obese. Ms. Hardy
explained that when her office started project planning in
2004, the Alabama Department of Public Health found
that 57 percent of women in Alabama were overweight
or obese, including 66 percent of women ages 45-54, 73
percent of black women, and over half of white women.
She noted, however, that this was self-reported data, and
in 2006, some of these data shifted.
Ms. Hardy explained that New Leaf is a lifestyle initiative
with a structured nutrition and physical activity program
and two assessment components developed by the
University of North Carolina (UNC) at Chapel Hill. The
initiative focuses on chronic disease risk reduction through
weight reduction with an emphasis on cardiovascular
health.
She went on to explain that in an effort to conduct
community outreach cost-effectively, the Alabama
Office of Women's Health used a pre-existing network
of community health advisors from the University of
Alabama that do outreach for breast cancer survivors.
They trained these advisors in the New Leaf curriculum to
conduct weight loss and healthy behavior change programs
in women ages 40-65.
Ms. Hardy stated that the program was implemented at
five sites in three counties, with one alternate county.
Based on meetings and focus groups, the curriculum was
modified to fit community health advisors' schedules and
training from the UNC nutritionist. Ms. Hardy noted that
they found the program needed to be long enough to bring
about change, but not too long to burden volunteers. The
result was a 6-month program. Each participant received a manual and participated in 14, one-hour sessions. They also met weekly for the first 8 weeks to get people into a
pattern of desired behavior changes. After that, they met
biweekly for 2 months and then met monthly for the last
2 months.
In closing, Ms. Hardy noted that one of the biggest lessons
learned is that communities are very eager for participatory
programs. She said if we can find ways to help them take
part in program planning from the beginning, they are
more open to the programs and will try to find ways to
sustain them.
Utilizing Community Health
Workers to Engage Colonial
Residents to Improve Health
Through Resident-Led
Community Partnerships
This workshop highlighted an innovative community
program for increasing access to care and improving
health outcomes for rural people in South Texas. Julie
St. John, M.A., M.P.H., South Texas Regional Director
at the Center for Community Health Development,
began by explaining that community health development
is a process by which a community identifies its needs,
develops goals, and plans and implements activities. She
went on to explain that the Center for Community Health
Development focuses on broader determinants of health,
social, psychological, physical, and emotional well-being.
Its work is population-focused, not individual-based. The
center pools resources as much as possible to improve
community health status.
Ms. St. John stated that the center received funding from
HRSA and the Robert Wood Johnson Foundation to create an Integrated Health Outreach System (IHOS). The goal of the project was to create a model to improve health status and access to care
in two clusters of colonias in Hidalgo County, Texas. The population
of 655,202 in Hidalgo County is 90 percent Hispanic. There is a 13.4
percent unemployment rate, and 36 percent of residents live below
the Federal poverty level. Sixty (60) percent are uninsured and more
than 20 percent, or 150,000-200,000, live in colonias. Colonias are
unregulated residential areas lacking basic services like water, electricity,
mail, and trash pick up.
Ms. St. John explained that the idea behind the project was to get
health providers to come together to serve residents. The area had a
network of agencies, including Planned Parenthood, a Federal clinic,
and a university program that provided transportation. They also had
promotoras and community health workers—lay people from the
community who live in colonias and have some training. In addition,
HRSA funded a federally qualified health center to open two satellite
clinics with full-time doctors, covering about 80,000 of the residents.
Ms. St. John noted that the project centered on a partnership approach.
Project planners assessed needs and conducted several key informant
interviews and focus groups led by the promotoras. From this work,
they identified a range of issues to address. Promotoras then led the
residents in prioritizing these issues, so they could start seeing an impact
as soon as possible. Residents decided to form three task groups to focus
on environmental issues, health, and transportation.
In closing, Ms. St. John stated that there were numerous successes.
Her team held health fairs and walkathons; developed a bilingual
resource directory of services; created a network of health providers
called the Colonia Health Improvement Network (CHIN); established
trash collection once a week in each area; and revised the IHOS
transportation service to be more user-friendly. In the last 3 months,
they have made close to 1,000 transports to appointments.
Conducting a Community-Based
Needs Assessment
This workshop highlighted the findings from an
assessment of the needs of a rural New Hampshire
community. Karen Horsch, M.A., Evaluation Consultant,
and Martha Hill, M.A., Director of the North Country
Health Consortium (NCHC), New Hampshire National
Rural/Frontier Women's Health Coordinating Center,
began by explaining that the assessment was a partnership
between the RFCC and the NCHC. The presenters noted
that it was a big step for the RFCC to determine the
needs of the community, because up to that point, little
to no data had been collected and organized about the
area. Through the assessment, the RFCC planned to learn
about the concerns of women and identify the services in
the North Country, help the services meet the needs of
women, and identify the role of the RFCC in meeting the
needs of women and care providers.
Ms. Hill noted that the project team developed a threepronged
strategy to collect data. They used focus groups
of women, interviews with providers, and an anonymous
survey distributed at women's health fairs.
Ms. Horsch reported that the fi ndings from the focus
groups and survey revealed that the lack of specialists,
lack of providers, transportation barriers, and lack of
parenting programs for new moms were perceived as the
biggest challenges facing women in receiving health care.
Many women lamented the "dehumanization"of health
care, especially older women. Ms. Horsch reported that
women also found it hard to form relationships with
doctors because the doctors often left the area within one
or two years. She said women also did not seek out Nurse
Practitioners and almost exclusively wanted to see their doctors. Also, the focus groups found that women
expected a prescription at the end of the visit, because they
equated a prescription with a solution.
The presenters noted that the providers interviewed
believed that health resources are inadequate for everyone,
not just women. The lack of training on women's health
was seen as a problem exacerbated by lack of funding and
the expense and time it takes to travel to training courses.
The providers also cited the diffi culty in recruiting and
maintaining staff, mirroring the frustration the women
expressed. The interviews suggested that the RFCC could
help with training, community education, and connecting
resources for service work.
Current as of October 17, 2008 |