Rural Women's Health Conference
Summary Report
Summary Report (PDF File, 1.82 Mb)
August 13 -15, 2007
Omni Shoreham Hotel, Washington DC |
|
Workshops, Part I
Improved Quality of Life Through Weight Management
This presentation focused on an approach to helping
fight obesity in the setting of a rural clinician. Wendel J.
Ellis, D.O., Greeley County Health Services, started this
informal program upon noticing that his prescriptions of
diet and exercise were ineffective and that more people
coming to the clinic with obesity were also suffering from
depression.
Dr. Ellis opened his presentation by noting that obesity
affects over 108 million Americans and greatly increases
health risks for many conditions, including hypertension,
type 2 diabetes, coronary heart disease, gallbladder disease,
certain cancers, dyslipidemia, stroke, osteoarthritis, and
sleep apnea. Obesity is defi ned as having a Body Mass
Index (BMI) of 30, or higher. Dr. Ellis noted that in adults
ages 20-74, the rate of obesity has risen from around 15
percent in 1976 to over 30 percent in 2003. As measured
by the CDC's Behavioral Risk Factor Surveillance System,
in 1995, no States had an obesity rate above 20 percent of
the population. However, by 2000, 22 States had obesity
rates over 20 percent.
Dr. Ellis explained that one of the reasons for the increase
in obese adults in America is the increase in the size of
servings. He then presented a series of slides, produced by
the CDC, comparing the average number of calories in
portions 20 years ago to the number of calories today. Due
to the increase in portion sizes, Dr. Ellis noted that people
ingest many more calories than 20 years ago, contributing
to the increase in the number of obese Americans.
Dr. Ellis outlined the four different types of therapy for
obesity:
- diet and exercise
- pharmacotherapy
- behavioral therapy
- surgery.
He emphasized that
the combination of a low-calorie diet, increased physical
activity, and behavioral treatment is the most successful
strategy for long-term weight loss and maintenance. This
approach to weight loss should be attempted for at least 6
months before considering drug or surgical therapy.
Dr. Ellis then described the details of the program he has
initiated in Greeley County, Kansas. After he sees a patient
and diagnoses obesity, a variety of things happen. First,
Dr. Ellis will work with a Registered Nurse (RN) to help
educate the patient and develop a plan of action to help
induce behavioral change. Dr. Ellis has taken the position
that obesity is an ongoing condition, like diabetes, that
cannot be addressed in one treatment cycle.
After the initial visit, the RN schedules weekly
appointments with patients, providing emotional support
and accountability to patients. The RN also helps patients
keep food diaries, develop exercise programs, and set
realistic weight-loss goals of 0.5 pounds per week.
In closing, Dr. Ellis presented testimonial letters from
two of his patients who had managed to lose over 50
pounds each. Both mentioned the positive effects of a daily
exercise routine and the importance of changes in lifestyle,
as well as the enormous importance of the RN in helping
them get through tough times in the program.
Health Experiences of Women Living in Rural/Frontier
Communities
This presentation summarized the fi ndings of a study
supported and conducted by the Wyoming Health
Council from 2006 to 2007 to explore the health-related
experiences of women living in rural/frontier Wyoming.
Susan McCabe, Ed.D., APRN, BC, Associate Professor,
School of Nursing, University of Wyoming, and Corinna
Seely, B.S., Contractor at the National Rural/Frontier
Women's Health Coordinating Center, Wyoming Health
Council, opened the presentation with an overview of the
study.
Dr. McCabe and Ms. Seely noted that the researchers
designed a qualitative study in which the main data
collection method was focus groups. In addition, a nested
study was conducted using photo-voice methodology, a
process through which participants are given disposable
cameras and asked to take photos of things in their
communities that represent health to them. Once the
photos are developed, the researchers discuss their meaning
with the participants.
The major research question addressed by the study was:
- What is the experience of health for a woman
living in rural/frontier Wyoming?
Sub-questions included:
- What are the main health concerns of women
living in rural/frontier communities?
- What are the supports and barriers to health?
- What is the impact of the experience of living in
rural/frontier communities on women's access to
care?
The focus groups were conducted in six communities
in Wyoming, representing various aspects of the State,
including geographic region, economic base, and
population diversity. Dr. McCabe and Ms. Seely noted
that a "snowball" process with key informants was used
to recruit women for the focus groups in each of the six
communities. A total of 45 participants were recruited,
ranging in age from 19 to 64, with an average age of 41
years. Ethnicity was self-reported, with approximately onetenth
reporting as Hispanic, and the remaining nine-tenths
split evenly between white and Native American.
Dr. McCabe and Ms. Seely stated that the focus groups
lasted between 50 and 80 minutes. Audio and video
recordings were made of each session and researchers
compiled fi eld notes. In addition, participants completed
health assessment surveys. The researchers also collected
data from other sources, such as the chamber of
commerce/visitor information center, newspapers, and
phonebooks, as well as community photos. A mid-process
review was conducted to determine whether changes to
the protocol were necessary. As a result of the review,
the researchers put more stress on the confi dentiality
of collected information, given the personal nature of
the information discussed and the closeness of the rural
communities.
The fi ndings identifi ed fi ve main concerns that were
consistent across all six groups:
- Lack of health insurance and ability to pay for
health care
- Strong sense of own expertise in personal health
and health-related issues
- Competing needs related to the health of family
members
- Unavailability of quality mental health care
- Difficulty of remaining healthy in a rural
environment
Dr. McCabe and Ms. Seely noted that the participants identifi ed
several factors that support good health, including the rural lifestyle,
which typically has less stress and is characterized by a more supportive
community; meaningful personal supports, such as the church, family,
animals/pets, and nature; the importance of personal independence
and self-reliance; and easy access to health information, most often via
the Internet. Participants also identifi ed several barriers to good health,
including the rural environment, especially the diffi culties of travel
(e.g., distance, time, and cost); environmental pollutants; disrespect and
cultural bias on the part of providers; the fragmented nature of care (i.e.,
having to travel to multiple sites to obtain services); and limited care
options.
The overarching fi ndings from the study were:
- Women are "straddling the line"—at any moment something
could happen that could result in catastrophe.
- Rural areas were perceived as both the best and the worst place
to be in terms of health.
- Many factors affect overall health and access to health care.
- Women are responsible for their own health and the health of
their families—they are the "glue."
Women's Behavioral Health Systems
Building: Innovative Ideas for Local and
State Collaboration
This presentation showcased an innovative women's behavioral health
program from Maine. Anne Conners, M.A., B.A., Project Specialist
at the Muskie School of Public Service, University of Southern Maine,
began the presentation by noting that substance abuse and depression
are growing problems in the State of Maine. Issues include prescription
drug abuse and binge drinking. In addition, Ms. Conners noted that
one in fi ve Mainers report experiencing depression. To help address
these issues, Maine received a Women's Behavioral Health Grant from
the HRSA Maternal and Child Health Bureau's Division of Perinatal
Systems and Women's Health.
Ms. Conners explained that the vision of Maine's
Women's Behavioral Health initiative was to integrate
screening for depression and substance abuse for women
of reproductive age into the primary care setting in
rural underserved areas. She went on to explain that
the program targets areas from all over the State. One
of the project highlights is that it aims to involve
systems, not just health centers. It also emphasizes
public-private organizations and the involvement of
grassroots organizations. In addition, because the HRSA
grant is nonrefundable, there is a large effort to build
sustainability.
Ms. Conners stated that project designers selected four
primary locations in four counties. Since the State of
Maine is the largest of the New England States, some sites
are as far as a 5- or 6-hour drive apart, and distance is a
constant challenge. The program designer's methodology
included three coordinating entities—the Women's
Behavioral Health Grant Steering Committee, the
Women's Behavioral Health Systems Initiative Advisory
Group, and the Demonstration Sites Leadership Team.
Each of the three entities contributed something unique to
the project.
Ms. Conners noted that although the project is still in
progress, they have already learned many valuable lessons.
Maine has a strong sense of community—people really do
pitch in and help each other. The health centers ended up
sharing information and resources, rather than competing
with each other. If one health center had a good idea, it
would share it with another. Another thing they discovered
was that women were more likely to come to an event if
there was a connection to their children.
In closing, Ms. Conners stated that one of the most
exciting outcomes of the program is that all four health centers plan to do universal screening. Their fi rst step is
to implement the screening for chronic disease patients.
It is important to acknowledge that although the process
is diffi cult, what helps is having support along the way.
They have also achieved policy changes—their project was
written into the State health plan.
Integrating Cognitive Behavioral
Therapy in Primary Care
Treatment of Depression and
Anxiety for Rural Women
This presentation summarized a program developed by
the Radford School of Nursing to educate primary care
providers in cognitive behavioral therapy (CBT). It was
presented by Radford School of Nursing faculty Janet
McDaniel, Ph.D., Professor of Nursing; Laura LaRue,
APN-BC, Instructor; and Sarah Strauss, Ph.D., Professor
of Nursing.
Dr. McDaniel began by noting that Radford University
is located in the Blue Ridge Mountains of Southwest
Virginia, approximately 13 miles from Virginia Tech.
There are numerous challenges to providing mental health
care in the area, including a lack of insurance and a lack
of providers. Many primary care providers and nurses
are not trained as counselors. In addition, there is a lot
of stigma associated with mental health in rural areas.
Transportation is also a problem, and there are long
waits for appointments. Dr. McDaniel explained that
Radford University received a grant from the Virginia
Health Care Foundation to educate providers in CBT.
She went on to explain that CBT is a psychotherapeutic
model that engages the client in a collaborative manner to
examine the way she constructs and understands her world
(cognitions), evaluate the process by which the individual acts on cognitions (behaviors), and challenge targeted
behaviors and cognitions to gradually change a client's
way of thinking, behaving, and interacting. Dr. McDaniel
noted that once you can modify the way of thinking, it
results in symptom improvement.
Dr. McDaniel outlined the three program objectives:
- Identify mental health needs of rural women
- Discuss cognitive behavioral strategies appropriate
for primary care
- Discuss issues in providing CBT in the primary
care setting
Dr. McDaniel then explained that the university
developed a three-credit course that focused on preparing
advance practice nurses (APN) to provide CBT. Eleven
providers participated in the three-credit course. Overall,
717 women and men were screened for depression, and
480 were screened for anxiety. Of those screened, 168
were recommended for further mental health services,
which was mostly CBT.
Ms. LaRue then summarized some of the issues they
encountered regarding CBT in primary care. They
included commitment, integration, time factors, and
dealing with CBT codes and documentation. Next, Dr.
Strauss walked participants through a sample screening.
Dr. McDaniel concluded the presentation by summarizing
the outcomes and fi ndings. She noted that CBT was
provided for 57 women experiencing depression and
anxiety over a period of 7 months. Seventy-fi ve percent of
the clients experienced decreased depression and anxiety
scores and adhered to their medications.
Dr. McDaniel stated one key fi nding was that those with
high Beck Depression Index and Beck Anxiety Index scores could be handled in the primary care setting if there
was no threat of harm to self and others. In fact, she noted
that most clients rejected referral to outside settings and
wanted to stay inside the primary care setting. The staff
also found that clients had an improved ability to identify
and use resources. Dr. McDaniel explained that the clients
were better equipped to make decisions about their care.
When confronted with new challenges, they self-referred
themselves back to the primary care provider.
Before It Starts: Domestic
Violence Prevention in Rural,
Frontier, and Geographically
Isolated Communities
This workshop provided an overview of the DELTA
(Domestic Violence Prevention Enhancements and
Leadership Through Alliances) approach to domestic
violence prevention. It was presented by Joshua Edward,
M.H.P. (in progress), DELTA Project Coordinator,
Alaska Network on Domestic Violence and Sexual
Assault; Karen Lane, M.Ed., State DELTA Project,
Coordinator, Montana Coalition Against Domestic and
Sexual Violence; Janelle Moos, M.S., DELTA Project
Coordinator, North Dakota Council on Abused Women's
Services; and Jennifer Wages, M.S.W., LCSW, Project
Coordinator, Center for Rural Health.
The presenters began by explaining that the DELTA
initiative is the CDC's primary domestic violence
prevention effort utilizing a public health approach to
address intimate partner domestic violence. The initiative
includes 14 State Domestic Violence Coalitions and
focuses on preventing fi rst-time perpetration and fi rst-time
victimization.
The presenters noted that intimate partner domestic
violence is defi ned as physical violence, sexual violence,
threats of physical or sexual violence, psychological/
emotional abuse, and stalking between current spouses,
former spouses, current non-marital partners, and former
non-marital partners. Many practitioners and researchers
use the term "domestic violence" rather than the term
"intimate partner violence" to refer to the same public
health problem. The presenters explained that the DELTA
program uses the term "intimate partner violence" to
clarify that this program does not address other public
health problems that are also referred to as domestic
violence (e.g., child abuse and elder abuse by relatives
other than an intimate partner).
DELTA is a population- and environmental-based
system level of services, policies, and actions that prevent
intimate partner violence from initially occurring. It uses
a community level process to identify risk factors and
maintain prevention implementation.
At its core, the presenters explained that the DELTA
program is a collaborative community-based effort that
incorporates sustainability from the very beginning of the
initiative. It views sustainability not as getting funding,
but as planning and supporting efforts to incorporate
prevention initiatives into existing community institutions;
making policy changes in the rules, regulations, and laws
of the community; mobilizing community residents to
own and lead prevention efforts; and fi nding sources of
revenue to support ongoing activities of the effort. Its
goal is to bring about long-term success by effecting social
change.
Listen to Women: Meeting the
Needs of Rural Women
This presentation highlighted approaches for providing
gender-appropriate care through health provider
recruitment and retention. Jill Alliman, M.S.N., CNM,
Center Director and Nurse Midwife at the Women's
Wellness and Maternity Center National Rural/Frontier
Women's Health Coordinating Center, and Julia
Phillippi, M.S.N., CNM, Lecturer at Vanderbilt
University, began by explaining that "Listen to Women"
is a slogan designed to remind providers to listen to the
women they serve.
Ms. Alliman and Ms. Phillippi explained that two primary
questions health care providers must ask are:
- Do women have the services they need?
- Do they feel "heard"?
Ms. Alliman and Ms. Phillippi asserted that these
questions matter to women, because there is a shortage of
care, and women are the gatekeepers. They often make
health decisions for multiple generations. We need to
provide gender-appropriate care and reduce the stigma
of access to care.
Ms. Alliman and Ms. Phillippi noted
that the shortage of care also matters to providers. They
explained that because of the shortage, there is an increased
load on existing providers, in addition to the fi nancial
burden of care, the malpractice crisis, and wanting to meet
the client's needs.
Ms. Alliman and Ms. Phillippi noted that the Women's
Wellness and Maternity Center was established 23 years
ago in response to the shortage of care in the area. It was
established primarily for prenatal care and delivery services,
but has added more services over the years. Through
its designation as an RFCC, the Center has expanded
its focus to include increased primary care, a continued emphasis on gender-based care, a referral and tracking
system, leadership development, community outreach, and
research and data collection.
The presenters explained that as we look at ways to
increase access, we need to look at providers' scope of
care. Several national organizations have information on
provider scope of care on their Web sites. They noted that
providers can also turn to State organizations and boards
that regulate practice. They
asserted it is especially
important to look at
reimbursement rates and the
larger regional network. Just
because something does not
work now, does not mean it
will not work 5 years from
now. They emphasized that
providers must keep trying.
Ms. Alliman and Ms.
Phillippi suggested that
when providers look at
their facilities' scope of
care and what they can
add, they need to think out of the box. They explained a
clinic may be really busy, but it may be possible to add a
nutritionist—she really only needs a desk and two chairs.
They went on to suggest that providers can also look at
expanding hours—many women are willing to work at
the facility into the evening, when their husbands can take
care of the children. The presenters explained the challenge
is sustaining the model over time. Providers should be
encouraged to think of their model as dynamic and to
think outside of the walls of the clinic.
Women Health Providers for
Rural Communities: Supportive
Networks to Ensure Recruitment
and Retention
This presentation highlighted one center's perspective
on achieving gender-appropriate provider recruitment
and retention. Barbara Levin, M.D., M.P.H., Medical
Director of the Women's Wellness and Maternity Center,
began by noting that the
retention and recruitment
process for fi nding and keeping
women providers in rural
communities is an ongoing
challenge. When Dr. Levin
attended medical school,
approximately 3—7 percent
of students were women.
Women now represent over 50
percent of students in medical
school, and more women
choose primary care specialties.
However, Dr. Levin noted,
fewer women choose rural
practice than men.
Dr. Levin explained that the future impact of this
issue is that more women in primary care may mean
fewer providers in rural communities. Yet, she noted,
documents show that very few people are dealing with
the issue on a policy level. The World Organization of
National Colleges, Academies and Academic Associations
of General Practitioners/Family Physicians (WONCA)
issued a resolution in 2000 stating, "Rural practice should
refl ect the way women experience their lives." Dr. Levin
explained this issue is important, because we frequently have to innovate. We need to think outside of the box,
because in rural places, there is not a box (e.g., a dental
center in a health clinic).
Dr. Levin stated that in Monroe County, Tennessee,
non-physician providers include 4 dentists (2 have stayed
and 2 have left), 20-plus nurse practitioners (11 are still in
practice), and 14 Certifi ed Nurse Midwives (4 are still in
the county). Dr. Levin then introduced her intern, Alana
Sagin, a second-year medical student at Jefferson Medical
School in Philadelphia, PA, who conducted a pilot study
of two East Tennessee counties on the issue of recruitment
and retention.
Ms. Sagin presented the results of her study. She began
by explaining that she developed a questionnaire, which
she followed with a face-to-face interview with 20 percent
of respondents. One thing she
learned immediately is that reasons
for coming to the county and
reasons for staying were fairly
similar. She noted that one of
the most common issues was
spouse/work opportunities. Other
important issues were diffi culties
adapting to small-town life.
Dr. Levin then noted that nearly
all women surveyed had heard
about the Women's Wellness and
Maternity Center. It was clear that
Monroe County had become a
place where you go for women's health concerns, which
was due in large part to the Center's work.
Dr. Levin discussed how she started conducting Leadership
Luncheons to help health care providers recognize that they are part of a larger network. She noted that nurse
midwives and practitioners were more likely to participate
in the luncheons than physicians and dentists, which is
evidence that there is still a great need for cross-discipline
interaction. Dr. Levin concluded by explaining that when
you are looking for women providers, it is very important
that they are embedded in the network.
Bridging Gaps in Access and
Quality for Women Through
Telehealth Programming in a
Rural Federally Qualifi ed Health
Center
This presentation demonstrated how telehealth can be
used effectively to improve health care for rural women.
Juliana Anastasoff, M.S., Chief Project Offi cer at El
Centro Family Health and
Director of the National
Rural/Frontier Women's
Health Coordinating Center,
began by noting that El
Centro Family Health serves
a 7-county region of 23,000
square miles with a population
density of 0.05—12.1 percent.
She explained that the
region is characterized by
remote mountain villages,
many of which lack public
infrastructure. For most of
the year, road conditions are
poor at best and even hazardous during certain times. In
the region, 70 percent of the population is at or below 200
percent of the poverty level, and 43 percent is uninsured.
Ms. Anastasoff noted that all but one of the 33 counties in
the region is classifi ed as an HPSA.
Ms. Anastasoff reported that El Centro received a grant
from the NRHA to fund a program that provided
technical assistance for the development of telehealth
capabilities. Telehealth was an attractive option to El
Centro because it can be a useful tool to reduce health
disparities; maximize effective utilization of resources;
reduce isolation of rural clinicians; facilitate the practice of
evidence-based medicine; and enable continuous quality
improvement.
Ms. Anastasoff explained that
the NRHA grant enabled
El Centro to hire a highly
qualifi ed consultant to help
them with this effort. They
identifi ed patient needs
through surveys, charts,
and meetings with the
community, and provider
needs through focus groups.
El Centro also assessed its
own needs by consulting
middle managers, senior
leadership, clinical leadership,
and the Board of Directors.
The fi nal plan prioritized:
- Tools to assist
clinicians in making decisions
- Access to specialist care
- Communication between rural health providers
- Improved internal communication
- Improved management of patient data
Ms. Anastasoff went on to explain that the technology they
identifi ed for achieving these objectives included electronic
health records, mobile computing devices, wireless Internet
access, and videoconferencing. Another technology-related effort of El Centro is its Web portal targeting women and
girls. Currently, it serves 1,300 users. She concluded by
noting that the Web-based approach is especially good for
rural teens, since many of them are very isolated.
Telehealth: Shrinking Barriers
and Expanding Opportunities for
Health Care
This presentation highlighted an innovative telehealth
network in the State of Utah.
Deborah LaMarche, B.S.,
Program Manager at the Utah
Telehealth Network (UTN)
began by stating that UTN's
mission is to expand access
to health care services and
resources within Utah and the
intermountain West through the
innovative use of technology.
UTN was initiated in 1996 and
is operated by the University of
Utah. The network is open to
any Utah healthcare provider
and there are currently over 40
members.
Ms. LaMarche explained that telehealth is defi ned as the
use of electronic information and telecommunications
technologies to support distant clinical health care,
professional health-related education, public health,
and health administration. Telehealth includes
videoconferencing, teleradiology, telepharmacy, remote
monitoring, and home health. It allows for real-time,
interactive communications, is user-friendly, and is
typically rated positively in patient satisfaction surveys.
Ms. LaMarche noted that while patients report telehealth
is not as good as seeing a provider face-to-face, they find
it much better than having to drive long distances to see a
provider. In Utah, telehealth has resulted in less isolation,
travel, and waiting by patients, as well as improved access,
quality, value, and continuity of care.
Next, Donna Jensen, Women's Health Director of the
Utah Navajo Health System National Rural/Frontier
Women's Health Coordinating Center, stated that one
example of UTN's partners is the Utah Navajo Health
Association (UNHA), a federally designated 330e
community health center that provides medical, dental,
and behavioral health
services.
UNHA uses
telehealth for telepharmacy,
services such as retinal eye
exams, echocardiograms,
and x-rays. Ms. Jensen
explained that an important
component of UNHA's
services is the use of
electronic medical records,
which allows providers
across sites to access
patients' medical records
and facilitates tracking of
services.
Since initiating the system more than 10 years ago, Ms.
Jensen reported that UTN has learned important lessons
related to all aspects of telemedicine. She noted that
there are a variety of strategies for optimizing telehealth,
depending on the setting. For example, with patient care,
it is important to ensure that there is written consent from
the patient, and that providers introduce everyone in the
room and do not allow any interruptions. Ms. Jensen concluded by stating that telehealth is also very effective in
educating providers. She asserted that such techniques will
make educational opportunities available to many more
providers and potential providers.
Cancer Suvivorship in Rural
Communities
This presentation summarized research on rural cancer
survivors. Camille T.C. Hammond, M.D., M.P.H., a
Program Director at the University of Maryland School of
Medicine in the Offi ce of Policy and Planning, began by
noting that cancer survivors have
been tracked as a group since 1971.
She stated that in the broadest
defi nition, anyone diagnosed with
cancer is a cancer survivor from the
time of diagnosis to death. Some
defi nitions also include caregivers
and family members of diagnosed
cancer patients as cancer survivors.
Dr. Hammond reported that
around 10.7 million Americans are
cancer survivors, which is about
3.6 percent of the population.
She explained that the number of
cancer survivors has increased over
time because of increased accuracy in detection, more
effective treatments for cancer, better supportive care, and
better long-term surveillance. Cancer has become more
of a chronic illness, rather than a death sentence, that is
addressed within the community (not as many trips to
out-of-town specialists).
Dr. Hammond explained that rural cancer survivors
have increased risks for poor outcomes, such as second primary cancers, late physical and psychological effects of
cancer and its treatment, unemployment following cancer
diagnosis, and dealing with role adjustment (especially
rural women, who feel being a patient interferes with
nurturing social roles). Oftentimes, rural cancer survivors
deal with senses of helplessness, hopelessness, posttraumatic
stress disorder, lack of emotional support, and
the physical distance from adequate care and information.
Dr. Hammond noted that rural caregivers (the informal
support provided by family and friends) also need help
due to limited access to healthcare services, transportation
problems, and geographic/social isolation. They need clear
and consistent messages about treatment goals and better
coordination between healthcare services.
Dr. Hammond said that healthcare providers noted
the need for training in treating cancer survivors. Many
primary care doctors are unaware of the possible side effects
and long-term health issues associated with specifi c cancer
treatments. She reported that providers also suggested a
"care plan" be given to patients following cancer treatment,
so they are always aware of the treatments used, type of
cancer treated, possible late side effects, and additional
information that would be useful for other doctors to know
before treating the cancer survivors.
Dr. Hammond concluded by stating that survivors want to
know how to reduce the effects of cancer, how to decrease
their risk of developing new cancers, and where they can
fi nd doctors familiar with late-term cancer effects. In the
future, we need interventions to improve quality of life for
underserved cancer survivors, provide support for informal
caregivers, and train doctors to increase awareness about
evidence-based followup care.
Poverty and Community Food
Resources as Determinants of
Insuffi cient Household Food
Resources Among Rural Women
This presentation summarized the fi ndings of studies on
rural women's nutrition. Joseph Sharkey, Ph.D., M.P.H.,
RD, Associate Professor at the School of Rural Public
Health, Texas A & M Health Science Center, Social and
Behavioral Health Department, opened the session by
noting that rural women have many challenges to a healthy
lifestyle, including high levels of chronic conditions,
low levels of available health support, poorer housing,
limited transportation, and limited access to resources and
programs.
Dr. Sharkey explained that healthful eating training
is focused on the individual choice level, without
taking into account issues of adequate resources, food
environment, and food security/food suffi ciency. He went
on to explain that connecting the Brazos Valley Health
Status Assessment (BVHSA) and the Brazos Valley Food
Environment Project (BVFEP) allows a snapshot of rural
women's health to be studied in the context of physical
surroundings.
Dr. Sharkey stated that the BVHSA surveyed over
2,000 individuals, of which over 60 percent were rural
inhabitants. Of rural participants, 73 percent were women.
Many households had children, and many also had
nutrition-related conditions, like diabetes, obesity, heart
issues, and hypertension. He noted that the survey found
that rural women had higher percentages of food insecurity
(ran out of food, no money for more); unbalanced meals
based on cost (too expensive to eat healthy); and skipping
meals to spread out food supplies. Rural women also
reported a much higher feeling of dissatisfaction with the
variety of choices available, number of stores nearby, and
food cost.
Dr. Sharkey explained that the BVFEP mapped all
of the food stores available in the area by satellite and
allowed researchers to see where respondents lived in
relation to store locations. Forty-one (41) percent of rural
women lived 10 or more miles one way from the nearest
supermarket, whereas most lived closer to a convenience
or small grocery store. Because the area has no public
transportation, access to different types of food supplies
severely limits food choices for many. Since supermarkets
are hard to access, rural women face higher food costs, less
healthy food choices, less fresh food, and increased risk
of inappropriate food choices. Rural women also are at a
higher risk for increasing levels of insuffi cient household
food resources due to limited fi nancial resources, children
at home, and limited community food resources.
Dr. Sharkey concluded by stating that the findings of
these studies suggest that there needs to be an increased
focus on rural areas and rural women. He noted that they
also suggest the importance of comprehensive community
health assessments that include the context in which
people live, including households, neighborhoods, and
communities.
Promoting Heart Health in
Rural Women: The Halfway
Perspective of an Intervention
Study
This presentation summarized the preliminary fi ndings of
a study being conducted on rural women's heart health. It
was presented by Pamela Stewart Fahs, D.S.N., Associate
Professor, Endowed Decker Chair of Rural Nursing and
Health at the Decker School of Nursing, and Margaret
Pribulick, RN, a student in the Rural Nursing Ph.D.
Program, both of Binghamton University. Dr. Fahs and Ms. Pribulick began by stating that the New York
Women's Health Care Partnership, based at Binghamton
University, and a research team at the University of
Virginia are conducting an intervention study to determine
whether rural women receiving Stage Matched Nursing &
Community Intervention (SMNCI) have greater lifestyle
behavior changes to support heart health than women who
receive only Community Intervention (CI).
Dr. Fahs and Ms. Pribulick explained that the study is
looking for measurable differences in SMNCI vs. CI in
dietary, smoking, and physical activity of rural women
in Orange County, VA, and Delaware County, NY.
The presenters noted that the outcomes to be measured
include:
- Stage of change (SOC) for each behavior—diet,
smoking, and physical activity
- Movement in SOC over time
- Change in modifi able physiologic and
cardiovascular risks (BP, BMI, Lipids, C-Reactive
Protein, Framingham Coronary Heart Disease
Risk Score)
Dr. Fahs and Ms. Pribulick noted that many of the
women participating in the study felt they were already in
the action or maintenance stage in one or more behaviors.
Seventy-six (76) women self-reported action in diet (eating
5 or more fruits and vegetables per day), while 24 women
said they had stopped smoking more than 6 months ago
(maintenance) and 44 reported they had 30 minutes of
physical activity on 3 or more days of the week.
Dr. Fahs and Ms. Pribulick explained that enrollment
in the intervention study is three-quarters complete, and
researchers are just receiving the 7-month questionnaires
for the fi rst enrollees. Before any speculation about
changes or results can be reported, the next 7-month questionnaires are needed. The presenters went on to
explain that what the study does present is that the women
enrolled are overweight, have one or more behavioral
issues, show beginning level risk factors, and have more
abnormal electrocardiograms (ECGs) than expected. They
concluded by noting that while there is currently not
enough data to indicate that there are stage changes for any
of the behaviors or changes in the physiologic outcomes
that are normally associated with cardiovascular risk, what
can be said is that the women have increased their healthy
behaviors just by being part of the study.
Going Red in Rural West Virginia
This presentation summarized the fi ndings of a pilot
project on women's heart health. It was presented
by Elaine Bowen, Ed.D., West Virginia University
Extension Specialist—Health Promotion at the Extension
Service National Center of Excellence in Women's
Health, and Sharon Brinkman-Windle, M.P.A., M.A.,
West Virginia University Mary Babb Randolph Cancer
Center. Dr. Bowen and Ms. Brinkman-Windle began
by explaining that the West Virginia Women Wear Red
for Heart Health Pilot Project uses an aggressive, yet
personal, woman-to-woman approach to bring culturally
appropriate heart health information to rural women
through a variety of communication channels
Dr. Bowen and Ms. Brinkman-Windle reported that
the fi rst step of the project was to create a community
advisory board, consisting of community stakeholders
such as CEOs, university stakeholders, local opinion
leaders, and local health entities—to explore what women
would want in an education program. The group then
conducted various focus groups to learn from women
in the community their experiences with heart health
messages and care, explore what they thought a successful
heart health education event would look like in their community, and what they thought was important to know about heart health.
Dr. Bowen and Ms. Brinkman-Windle stated that from
this information, the project organizers developed four
main events:
- A Heart of the Mountain video that presented
stories of West Virginia women who were heart
disease survivors
- Heart Health is Fashionable—a health education
lunch and fashion show
- Training events for extension personnel on how
to hold "Love Your Heart Talks" for heart health
education
- Media outreach timed to correspond with the
American Heart Association Go Red campaign
Dr. Bowen and Ms. Brinkman-Windle reported that the
response to all methods of community communication
was overwhelmingly positive. Women indicated they liked
the focus groups as an opportunity to shape the events.
Women connected with the stories in the Heart of the
Mountain video and could identify with the survivors. The
video was featured at American Heart Association media
events and distributed to 173 public libraries.
The pre- and post-tests from the Heart Health Is
Fashionable events showed signifi cant changes on all
metrics used and was replicated to reach a total of 401
women. The training in Love Your Heart Talks reached 12
women in Wood County, and 16 community organizers
were trained at statewide training, who will then train
women in their communities.
The presenters concluded by reporting that the program
has ongoing support from the American Heart Association
and additional community trainings are scheduled. In
addition, the results of the pilot will be published in
scholarly journals and the State Medical Journal.
Current as of October 17, 2008 |