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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.
2009 Project Description
Established programs of the Health Education Extension Leadership, KY project are being carried out in all 120 counties of Kentucky. Cooperative Extension was involved in 2,145 joint programs with other organizations focusing on comprehensive health management. Extension specialists have developed or enhanced existing programs. These include Taking Ownership of Your Diabetes, Weight the Reality Series Body Image module, and 12 new story books and lessons in the Literacy, Eating, and Activity for Primary Youth Health (LEAP).
A Wally Cat cartoon wildcat was developed to reach youth and parents in a monthly newsletter series. A firstname.lastname@example.org email address was established for the newsletter series. School nurses working with their local Extension Agents distributed the newsletters and encouraged youth engagement. Wally Cat was also used on flu prevention posters, hand washing posters, covering cough posters, and on posters promoting flu vaccine clinics. These posters were used in hospitals, clinics, schools, and college dormitories across the state.
Adult monthly health bulletins on timely topics continue to be developed and circulated statewide. Three multi-college, multi-disciplinary teams are currently in the second year of program development and implementation.
Blue to You, a mental health program developed through a collaboration of the Department of Family Studies and the College of Medicine, has been piloted in nine counties in Western Kentucky. The curriculum is currently being revised based upon the pilot data, and is in the review committee process. It is expected to be implemented statewide during the spring of 2010. The Reaching Low Income Smokers through Culturally Appropriate Messages, a collaboration of the School of Human Environmental Sciences and the College of Nursing, developed appropriate messages from focus groups of smokers and former smokers, in Lawrence County Kentucky. The program is currently being piloted in that county and will be evaluated based upon the increases in numbers of local residents enrolling and completing smoking cessation classes. The program is being piloted through the local Extension Office with the assistance of the local health department. Products include brochures, local call in radio programs, cable television programs, newspaper coverage, and materials featuring local people and quotes from the focus group proceedings. A local quilt club constructed a quilt wall hanging to be used as a traveling story board of the themes from the focus group data.
The men's health pilot has finished its data collection from focus groups of men conducted across the state. This project is a collaboration of the College of Public Health, the Department of Kinesiology, and the School of Human Environmental Sciences. Data shows that men become less active as they age with a critical window to prevent inactivity in males being the early thirties age group. Focus group data indicates the need to tie family responsibilities to physical activity for this age group of men. This project is still in the program development stage and is expected to be piloted in the fall of 2010.
During 2008-2009, Extension agents made 324,942 contacts in health and wellness programs, 54,603 of those contacts were made in physical activity programs. 113,418 individuals reported a change in knowledge and/or skills regarding lifestyle changes that will improve their health. 50,754 Kentuckians reported making lifestyle changes for the purpose of improving their health.
16,647 youth were involved in the Literacy, Eating, and Activity for Primary Youth Health (LEAP) program across the state. 10,851 children demonstrated proper hand washing techniques. 14,671 children sampled a variety of foods which included fruits and vegetables and 12,560 children increased their level of physical activity.
Of 1,829 participants in Weight the Reality Series (WTRS), 722 succeeded in losing 5% of their body weight during the program. Three months following the program, 273 of 340 returning evaluation follow-up surveys, reported that they were maintaining their weight loss from the WTRS program. 153 participants reported continuing to lose weight.
262 participants reported having a more positive body image after completing the new module, Becoming Body Wise.
Taking Ownership of Your Diabetes reached 136 participants in 15 counties. This program is a partnership of County Extension Agents, Diabetes educators, dietitians, physicians, and other resource experts. The program teaches basic information on controlling diabetes through improved diet, physical activity, foot care, and regular testing of blood glucose and A1C levels. Physicians are now referring patients to the local Extension offices. Many of the participants have reported being in denial of their diabetic condition. One woman reported having been denial for more than 20 years.
Small Steps to Health and Wealth (SSHW) is a program teaching 25 "small steps" that participants can take to simultaneously improve their health and increase their wealth. There are many similarities between health and personal finance "issues" and behavior change strategies. The only difference is in their application. This program was conducted in 43 counties with 2253 participants. 799 tracked current eating and/or spending habits, and 931 selected a strategy to change their behavior with 853 participants reported adopting a health or financial behavior.
Two Family and Consumer Science Agents served on a Kentucky Public Health Leadership Institute change project team developing a Home Visitation On-Line safety curriculum approved for social work and nursing CEUs by the Kentucky Public Health TRAIN system. To date 180 registered users have completed the module with 100% of the participants learning at least 5 safety tips to utilize when conducting home visits.