Matheson McDonald Team MATCH

Campbell University Public Health Community Health Ambassadors Program

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Macropost #4

F9- Design a population-based policy, program, project or intervention

F19-Communicate audience-appropriate public health content, both in writing and through oral presentation

As our practicum days come to an end, I would like to take a moment to reflect on our experience. At the beginning of the school year, we signed up for the practicum group MATCH, which stands for Mobilizing for Action to Improve Community Health. We were suppose to develop partnerships and use the 4 phases of the MAPP assessment with the North Carolina Cooperative Extension Harnett County office. During our first meeting with our preceptor, the community development officer, she expressed her desire to develop a Community Health Ambassador Program (CHAP) to Harnett County, with the intention of helping the community eliminate health disparities. The description of our expectations and the program were very vague as we explained she wanted to see our creativity come to life through this program. Allowing students to use their own creativity instead of telling them exactly what needs to happen is a downfall for some who love structure and details, and it is a blessing for others who love to let their creativity run free. The team’s limited knowledge and assignment confusion lead us to come together to decide that we had to work together to figure this practicum assignment out. As we began researching and trying to figure out what in the world we were even supposed to be doing, we started our journey to growing and collaborating together as a team. However, little did we know that it would only be us left in the end. Team MATCH had to stick together to decipher what we each took from the instructions and our individual research on CHAP. We all explained our visions and goals for the project and what we ultimately envisioned happening. During this process, each individuals’ personality began to shine and we all discovered each other’s passions and interest. We had one more meeting with our preceptor to inform her on our progress with researching CHAP and what we envisioned the program going like. With little guidance, she just wanted us to come up with our own creative solution. As time proceeded, the group continued to work on each’s part. As we tried to reach back out to our preceptor, we discovered she was missing and unresponsive to any outreach. This brought the group to a devastating whirlwind. We felt abandoned and truly stranded. We began to compare ourselves to other groups and the feelings only grew worse as we began wallowing in our self-pity. Then as a team we came together to decide that we had to move forward, the show could not end here. We made the decision to not compare ourselves to other groups because we were all on our own separate paths. I believe this helped us push forward and continue theoretically envisioning how this training program would pan out. As we began pretending how the training would happen, we began to ask ourselves some valuable questions. What the community leaders would need to learn about and why? How would this benefit the community? How are we going to get the community leaders together to discuss their perceptions on what they believe are the most important problems Harnett county faces and what unique solutions they had to tackle the issues? Also who in the world would we want to invite to sit at the table? What kind of diversity would benefit the community the most? How could we reach more individuals, especially the ones with health disparities and who need the messages the most? And most importantly, how could we advocate for the residents of Harnett County and recruit more community ambassadors to get together and make a difference for their community? We wanted to show them how to focus on the strengths and resources the community already possessed instead of finding everything that is missing. As a team we did not want them comparing themselves to other communities and wallowing in self-pity of lack, like our team ultimately did at first. Team MATCH strived to empower the community ambassadors to understand they have a voice, they had power, they could speak up, and by educating the community leaders they could reach out and touch the lives of so many in Harnett County. Our ultimate goal was to make Harnett County a better place and mobilize the resources needed to lead to a better quality of life. Our dreams and aspirations for this program did not go as planned from the beginning; however, there was so much more we received from this project. Normally when people begin creating programs or projects, their minds limit them to what they believe is possible and not possible. They limit their potential and possibilities. Team MATCH was not defined by any limitation and every goal, thought, vision, and desire was possible in our minds. We created a program that we know in our hearts would change the community if it were to become implemented. COVID-19 has brought some unique challenges and now more than ever, Harnett County residents need our support, advocacy, and help. In the end this is the best possible experience we made out of it. Without limitations and expectations, we allowed our creativity to come to life. We developed a program that we are sure would help eliminate health disparities in Harnett County as soon as it was implemented.

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Become a Community Health Ambassador and change the quality of life for your community! Watch our video from Team MATCH! 

https://youtu.be/FCTR3rnVGMA

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Macropost #3

R1- Differentiate the impacts of social determinants of health that contribute to health disparities in rural communities as compared with urban communities

R3- Identify and distinguish the access to care barriers and the health care utilization challenges that affect the health of rural communities

As learned in our Rural Health class, zip codes are a better predictor of health than genetic code. The social determinants of health are social and community context; education; economic stability; neighborhood and built environment; and health and health care. Examples of social and community context include family structure, social cohesion, perception of discrimination and equity, civic participation, and incarceration. Some examples of education are high school graduation rates, school policies that support health promotion, school environments that are safe and conducive to learning, and enrollment in higher education. Economic stability examples are poverty, employment status, access to employment, and housing stability. Examples of neighborhood and built environment include quality of housing, crime and violence, environmental conditions, and access to healthy food options.

Rural areas are disproportionately affected by the social determinants of health that are likely to contribute to their health disparities compared to urban places. Rural residents tend to have less resources, are geographically dispersed, more likely to be uninsured, live in poverty, be unemployed, and have low education attainment compared to their urban counterparts (Warren & Smalley, 2014). Rural areas lack access to primary care, specialty care, employment opportunities, quality education, transportation options, and they tend to especially lack access of healthy food options. Below is how my practicum group, Team MATCH, worked to help eliminate some of the health disparities that Harnett County residents faces, with these social determinants in mind. My practicum group worked with Harnett County's North Carolina Cooperative Extension. Some of the significant issue's Harnett County's Cooperative Extension selected to address was leadership development and healthy eating, physical activity, and chronic disease risk reduction. Our preceptor was part of the Community Development branch, which designs programs to build healthy and thriving communities. The plan of work related to the County Government's objectives with economic development goals and developing a skilled and educated workforce by providing educational and training programs for Harnett County's residents and leaders. Team MATCH stands for Mobilizing for Action to Improve Community Health, a salutogenic pathway in itself. We developed a Community Health Ambassadors Program (CHAP) designed to train community leaders from diverse populations to help eliminate health disparities such as diabetes, heart disease, cancer, and substance abuse in Harnett County. The health disparities in rural areas are stricken with geographic isolation, scarcity of healthcare providers, distrust of health care providers, and lack of transportation to treatment. Community members can serve as influential leaders within their communities to promote disease awareness, management, and prevention. By bringing a variety of diverse voices to the table, we could have various approaches to solve the community problems with greater collaboration and better allocation of the community's resources. Rural areas tend to have fewer partnerships and resources to choose from than urban places (Warren & Smalley, 2104). Rural areas have specific risk factors like less access to health care through traditional settings, less social support, fewer resources available, and less staffing (Warren & Smalley, 2014). Cooperative Extension focused on addressing risk factors through a rural determination lens. The organization designed the program to eliminate distance and transportation barriers by bringing health to the community members where they already live, work, and play, which also helps with the lack of access to traditional health care settings. The program also focused on the lack of access to resources by bringing community leaders together to improve resource allocation. Cooperative Extension worked to enhance protective factors by building support in the community, enhancing individuals' problem-solving skills, identifying and mobilizing resources in the community already, and increasing the awareness and support from community leaders. With the limited amount of resources rural areas like Harnett County have, using community leaders is the most efficient, cost effective way to reach the other community members. The limited amount of resources also makes it crucial to utilize the resources that are there, build on those, and make sure other individuals in the community are aware of the resources as well. This organization also focused on rural composition by increasing the knowledge, skills, and education of health diseases by raising awareness and teaching self-management in a culturally tailored way to Harnett County and involving the community leaders they already trust and respect. This work would be different when applied to an urban setting because more resources are available, more community partners to train, and not as big of a transportation barrier.

Reference:

Warren, J., & Smalley, B. (2014). Rural Public Health. Springer Publishing Company.

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Substance Use in Harnett County, NC is this weeks focus! This is a crucial area for Harnett County as noted on the Community Health Assessment by community residents. Understanding policies around Substance Use and decreasing stigma can help. 

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Macropost #2

F14. Advocate for political, social, or economic policies and programs that will improve health in diverse populations

Advocacy is a crucial part of public health. As a society we need to come together to create change. We need to stand for what we believe in and show what is affecting our communities. Lawmakers are not always aware of the consequences some of their actions have on communities or what the health of certain communities looks like. They are not always aware or have to live with the downstream affects that come from some laws and policies. Congress members are also not aware of all of the statistics and what the community wants—unless the community speaks up. As public health leaders, it is Team MATCH’s hope to empower the Community Health Ambassadors(CHAs) of the Community Health Ambassadors Program (CHAP) to come together to discuss what is affecting their community and what they want to change about it. We strive to make sure the Harnett County community is aware that their voices have power to make a change. The CHAs hold the power in their hands to change the health of their community and Team MATCH plans to be by their side to support them along the way. Below are some of the policies and programs Team MATCH advocated for in the training manual.

Substance Use in Harnett County, NC

In 2017, 2018, and 2019 Harnett County residents ranked substance abuse prevention as the number one health behavior that the community needed more information and support about, according to the Community Health Assessment’s.

Good Samaritan Law Team MATCH advocated for awareness of the good Samaritan law of North Carolina that prevents those who call for help to get in legal trouble. The law protects citizens from trial in court for having small amounts of drugs on them or any illegal drugs that were taken. The law is to keep the focus on keeping the individuals life first. This protects the individual or friend who calls for help. This law needs to be widely known, since overdoses can be reversed before leading to a death, so time is crucial. We never want those to question calling 911, due to the fear of punishment. The hope of this law is to influence individuals who distrust the government or police. This law is crucial for everyone to understand due to the critical time aspect of getting to someone during an overdose. It is even more crucial for those living in rural areas, like Harnett County, where the distance for emergency vehicles to access them may be greater.

Naloxone Access Laws This North Carolina law protects those who give naloxone to someone who is having, or about to have, an overdose from criminal suits. These laws involve needing to understand what a drug overdose is, and how to recognize and respond to it. This law requires individuals to know what the drug Naloxone is, the purpose of using it, and where to find it. Naloxone is a FDA-approved medication that reverses the effects of an opioid overdose by blocking receptors in the brain and restoring breathing. Some places to obtain naloxone include: certain pharmacies in NC, NC Health Departments, Syringe exchange programs, and doctors may prescribe it. The CHA’s would also be further educated on the signs of overdosing, who should have naloxone on hand, and how to respond to an overdose.

Cancer in Harnett County, NC Cancer is the second leading cause of death in Harnett County and is slightly higher than North Carolina’s average rate. Between 2013 and 2017 North Carolina’s all-cause cancer rate decreased by 5.7% while Harnett County’s rate remained the same. One program that shows hope for uninsured women is UNC REX Mobile Mammography van. As Harnett County is rural and rural areas are more likely to have uninsured individuals, this program would benefit Harnett County.

REX Mammography Mobile Van Program One program Team MATCH advocated for was UNC REX HealthCare Mobile Mammography assistance program that is designed to help uninsured women, in our surrounding areas in need of a screening mammogram through the REX Mobile Mammography Coach at their medical clinic, local health department, or a community event. We wanted to get the community leaders together to decide on a community event to host and bring the mobile van to. This would help eliminate many transportation barriers that rural areas often face by bringing the screening care to them. This early detection prevention strategy is crucial for Harnett County as cancer is the second leading cause of death and female breast cancer deaths in Harnett County in 2018 accounted for 6% of those deaths.

Conclusion Advocacy is so crucial for public health and especially for rural areas like Harnett County that have health disparities and specific challenges. It is important that the community understands their voices have power and can make a difference. It is also crucial for them to know we, as public health candidates, are advocating for them as well. Team MATCH advocates for Harnett County and is providing the community health leaders with tools to be able to advocate for themselves and allow other community members to as well.

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Harnett County has a disproportionate rate for heart disease compared to North Carolinas average death rate. This calls for a need for Team MATCH to conquer. Raise awareness of heart disease and healthy lifestyle! 

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Macropost #1

F2- Select quantitative and qualitative data collection methods appropriate for a given public health context

F7- Assess population needs, assets, and capacities that affect communities' health

Team MATCH used Harnett County's 2019 Community Health Assessment (CHA) to identify the needs of the community. Harnett County’s top 5 identified health priorities in order are Diabetes/Nutrition, Heart Disease, Cancer, Education, and Mental Health. The local health department is expected to assess the communities health and make recommendations regarding the identified priority areas. The hopes are to create programs that will prevent diseases, promote health living, and create policies that will be of greatest benefit to the community. Some of the data was used from the local hospital system, Harnett Health’s, community health needs assessment, released in September of 2019. Harnett County has a population of 132,754 persons in 2017 according to the U.S. Census Bureau, with a median age of 33.4. According to the U.S. Census Bureau, Harnett County is predominately White (67.5%) and African American (21.2%), with 32.5% minority groups. 86.2% of Harnett County is a high school graduate or higher. According the to U.S. Census Bureau, Harnett County’s median income in 2017 was $50,323, which is very similar to North Carolina’s median income. The percent of residents in Harnett County living in poverty in 2017 is 18.0%, which is a slight increase since 2013.   The primary data from the community health survey for the Community Health Assessment was not exactly representative of the population. There was an oversampling of women, higher income, white, and educated respondents. The group disagreed with the statement that “There is plenty of economic opportunity in Harnett County”, but over 75% agreed there is good healthcare, Harnett County is a good place to raise children, grow old, safe place to live, and that there is plenty of help for people during times of need. The respondents believed that Substance Abuse Prevention and Eating Well/Nutrition were the highest priority health behavior that the community needs more information about. They also reported that Low Income/Poverty was the one issue that affected the people of Harnett County’s quality of life. The respondents believed the 6 following services were in need of most improvement in the community: higher paying employment, better/more recreational facilities, better/more health food choices, more affordable health services, positive teen activities and counseling/mental health/support groups. The secondary data showed that Harnett County ranked 49th out of 100 for health outcomes and 89th for clinical care while access to care is poor with only 1 primary care physician for 3,540 people. Harnett County has 1 mental health provider for every 1,130 people compared to North Carolina’s average at 1 for every 440. The leading 10 causes of death for Harnett County respectively is heart disease, cancer, chronic lower respiratory diseases, cerebrovascular disease, other unintentional injury, diabetes mellitus, Alzheimer’s disease, unintentional motor vehicle injury, pneumonia and influenza, and suicide. With the data statistics that Team MATCH found above, we decided to focus on Diabetes, Cancer, Heart Disease, and Substance use. Harnett County is a rural county that is characterized by geographic isolation, agriculture, poverty, religion, behavioral norms and stigma (Warren & Smalley, 2014). Those residing in rural areas are less likely to receive recommended preventive services (Warren & Smalley, 2014). Rural residents are also less likely to have the resources needed to access traditional medical care (Warren & Smalley, 2014). The Community Health Ambassadors Program (CHAP) would help bring health care to the residents. By training community leaders, Harnett County residents would receive health information and support from where they live, work, and play. This program helps to meet those in rural areas like Harnett County, where they are at, keeping in mind the barriers they face to help them achieve their best quality of life.

Reference:

2019 Community Health Assessment Harnett County. (2020, March). Retrieved November 30, 2020, from https://www.harnett.org/health/downloads/harnett-cha-2019-final-rev.pdf

Warren, J., & Smalley, B. (2014). Rural Public Health. Springer Publishing Company.

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Cancer is another top priority to address for Harnett County. Cancer is another focus of Team MATCH. Community Health Ambassadors will learn about cancer and prevention strategies to implement in their community. 

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Team MATCH had a wonderful team meeting this week to discuss the next steps moving forward! With the CHAP training manual almost complete, the next steps are to engage with community partners to assist us in our work moving forward! So excited to see what the last couple of weeks brings.

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Team MATCH is planning how to incorporate our deliverables into public health competencies and domains 🤩. The CHAP training manual is coming along great! Can not wait for everyone to see the final product!

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First step to managing diabetes is learning about diabetes. Your knowledge could help someone else.

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Another week down for team MATCH. The training manual is coming along great. The first step is making people aware. Can’t wait to see how our training turns out.

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Farmer’s are at extremely high risk for suicide and Cooperative extension has resources available to help! September is also suicide awareness month! Let us all spread awareness!!

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After working with the team to go through Harnett County’s Community Health Assessment the health department put out in 2019, we have decided to focus in on Diabetes, Heart Disease, Cancer, and Mental Health. Each team member picked a condition they wanted to specialize in, to be able to effectively train others. I picked Diabetes, and I can not wait to learn more about this health condition!!

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This week our team got together to come up with our big next steps! We all decided on who wanted to be leaders in each of the domains and we are all off to a great start! Next week we are deciding on what we want included in our training manual. So excited.

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Last week our team MATCH, met to discuss our practicum assignment. We will be proudly working with Harnett County’s NC Cooperative Extension to develop a CHAP training. MATCH stands for Mobilizing for Action to Improve Community Health. CHAP stands for Community Health Ambassadors Program.