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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.
2010 Project Description
Established programs of the Health Education Extension Leadership, KY project are being carried out in all 120 counties of Kentucky. Extension specialists have developed or enhanced existing programs. These include A Matter of Balance, an evidence based program focused on reducing the fear of falling, increasing physical activity, and learning fall prevention strategies for those 55 and older, Health Literacy Partnerships, Substance Abuse Partnerships, and three multi-college, multi-disciplinary teams are currently in the third year of program implementation.
Extension Agents have received training in Blue to You, a mental health program was developed through a collaboration of the Department of Family Studies and the College of Medicine and piloted in nine counties in Western Kentucky.
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 was piloted in that county and evaluation shows the increases in numbers of local residents enrolling and completing smoking cessation classes.
The men's health project, All Star Dads, is being implemented in three pilot counties. This project is a collaboration of the College of Public Health, the Department of Kinesiology, and the School of Human Environmental Sciences. It applies the principles of Social Marketing to address increasing men's level of physical activity through involving them with activities involving their children.
The Faces of Substance Abuse conference provided training for diverse community partners and county extension agents. Of the 172 participants, 94.7% indicated that after the training they felt as if they could impact the prescription drug abuse problem. 98.3% of the participants felt more confident of their knowledge of prescription drug abuse after training.
In 2002, 36,027 Kentuckians reported making lifestyle changes to improve health because of participating in Extension health programs; the number has progressively increased to 103,541 in 2009/2010. The number of joint programs conducted with public health partners has increased from 1,150 in 2002 - 2154 in 2009/2010.
A random research survey showed a significant difference in the positive responses of residents being able to support aging community members with mental health issues from counties receiving a mental healthiness intervention compared to groups of counties receiving a social media program only, and control counties receiving no intervention.
During 2009/2010 19,656 individuals reported experiencing a change in knowledge, opinions, skills, or aspirations regarding lifestyle changes in diet, exercise, etc. that improved their personal health. 20,255 youth participated in Literacy, Eating, and Activity for Preschool (LEAP) youth.
Participant evaluations of the Matter of Balance program report feeling more comfortable talking with others about their fear of falling, 94% made changes in their environment, 100% felt more comfortable increasing their activity, and 83% were currently exercising. One participant said "My thinking has changed. I believe that exercising can help prevent a fall. Before I didn't know if I thought it could make a difference. I started to do some moderate exercise and there is less clutter in my house."
Community Based Participatory (CBPR) project, Reaching Low Income Smokers: A Collaboration with County Extension Agents, developed and pilot tested an innovative, culturally sensitive intervention to maximize reach of tobacco treatment strategies with low income smokers in economically distressed counties in Eastern Kentucky. A survey conducted revealed that exposure to the intervention was predictive of talking with a doctor about quitting; further, those respondents with a higher dose of the intervention were even more likely to say they would talk to their doctor about quitting. This project is significant because Kentucky was the nation's largest producer of burley tobacco and dark fire- and air-cured tobaccos; it is an example of Extension being utilized to address complex health problems in Appalachia and its' ability to transfer the Extension Diffusion Model from growing tobacco to changing the health status of communities.