Montana State University
MSU Extension > Community Health Resources > HERE

MSU Extension's Community Health Resources Program

337 Culbertson Hall
P.O. Box 172230
Bozeman, MT 59717

Tel: (406) 994-5552
Fax: (406) 994-1756
Location: Culbertson Hall
dyoung@montana.edu

Community Health Specialist:

David Young

MSU Extension - Community Health Resources

College Department

Health Enhancement for the Rural Elderly (H.E.R.E)

Overview


With the goal of improving the health literacy, health care decision making, and self-care management of rural seniors aged 60 and above, the one-year project, Health Enhancement for Rural Elderly (HERE) was launched in September, 2008, funded by the U. S. Department of Agriculture (USDA). The project is continuing into 2010, a no-cost extension year, with supplemental funding from the National Network of Libraries of Medicine Pacific Northwest Region (NN/LM PNR). The primary benefit of this project is the enhancement of the health and well-being of rural seniors by increasing their access to, knowledge about, and understanding and use of basic health information. In addition, the community infrastructure is being augmented by providing each participating rural senior center with new equipment and materials. The intended outcome is that the seniors’ level of health literacy, health care decision-making, and self-care management will be improved, and that local senior centers will become the central hub for engaging seniors in this quest.

Background
Montana’s population is aging at a faster rate than is that of the rest of the nation.  Montana currently ranks first in having the largest share of Medicare beneficiaries living in rural areas (77 %) as compared with a nationwide average of only 24%.  According to the U. S. Census projections, by the year 2025, Montana will rank in the top five states for overall percentage of elderly state-wide, with over 25% of the population expected to be 65 years old or older.  Care for Montana's seniors is complicated by the state’s rural agricultural environment, which is characterized by long travel distances, poor secondary roads, long winters and inclement weather, and limited community-based services.

HERE Project Description – Year 01
Four rural communities in eastern Montana (Terry, Forsyth, Wibaux, and Scobey), each with a disproportionately high population of seniors, participated in the HERE project.  The local senior center in each community served as the central facility where program activities were developed and implemented.  Through a variety of programs with the senior centers, the goal was to improve the health literacy of rural seniors and build infrastructure within the senior centers.  The HERE research team worked with the senior center staff members, extension agents, public health nurses, and librarians in each community.

The three primary aims were to:  a) enhance the capacity of rural seniors to access, understand, and use basic health information resources and health promotion activities; b) encourage and motivate rural seniors and their family members to take more responsibility for their own health and self-care management; and c) empower rural seniors, family, and community members with knowledge and skills for improved health and health outcomes.

HERE Project Programs - Year 01
To address the aims of this project, three programs were offered:  a health literacy hands-on workshop, the use of My Health Companion ©, and a train-the-trainer workshop on caregiving.  Fliers and news releases were prepared to announce the HERE project, and Drs. Weinert and Young traveled to the four selected rural communities to conduct Town Hall Meetings.  These meetings were held at the local senior centers where the HERE project was introduced, contact information for participants interested in My Health Companion ©was collected, and an open session for questions and answers was held.

Health Literacy Workshops.  The “Prescription for Success: Guiding Rural Elderly to Quality Health Information” two-hour workshop was presented in each rural community.  Gail Kouame, Consumer Health Coordinator, NN/LM  PNR, University of Washington, traveled with Drs. Weinert and Young to conduct these workshops.  She presented hands-on training for older adults in the use of the computer to access health information as well as evaluate and process such information – keys to improving health literacy.  The workshops were enthusiastically engaged in by a total of 26 individuals who completed the pre-work shop questionnaire, participated in the hands-on learning activities, and completed the initial (T1) and follow-up mail questionnaires (T2, T3).  (T2 was administered immediately following the workshop, and T3 was sent a month after the workshop).  While the sample size was small, the results are gratifying.  There was a significant increase from T1 to T2 and from T2 to T3 for both computer skills and confidence in searching for health information.  Likewise, the participants’ overall health knowledge increased significantly from T1 to T2.  On a scale of 1 - “Strongly Agree” to 10 - “Strongly Disagree,” there was a strong mean score (1.92) for their willingness to recommend the workshop to others in the community.  On a scale of 1 - “Strongly Agree” to 10 - “Strongly Disagree” the overall mean was 5.56 for the need for follow-up assistance to feel confident enough to search for health information on their own.

My Health CompanionMy Health Companion © is a paper-based personal health record designed to help individuals with chronic health conditions to better manage and understand their health information and enhance productive partnerships between them and their health care providers.  Across the four rural communities, 60 individuals participated in the My Health Companion © component of the project by completing the initial questionnaire and had use of the personal health record for six months.  The six-month follow-up questionnaire was completed by 46 individuals of whom 32 had actually used the personal health record.  Questions were rated on a scale of 1"Not Useful At All” to 6 “Extremely Useful.”  For results, see the following table:

Results from My Health Companion © Questionnaire

Question

Mean Score

How useful was My Health Companion © in helping you to better manage your chronic illness?

3.04 (sd=1.03)

How useful was My Health Companion © in helping you to better prepare for visits with your health care provider?

3.39 (sd=1.10)

How useful was My Health Companion © in strengthening your relationship/partnership with your health care provider?

3.19 (sd=1.33)

How useful was My Health Companion © in helping you to better organize and track your personal health information?

4.14 (sd=1.27)

Would you recommend My Health Companion © to others?

4.57 (sd+1.23

Powerful Tools for Caregivers.  A workshop, Powerful Tools for Caregivers, a nationally known, two-and-a-half day interactive training program with emphasis on empowerment and self-care of informal caregivers, was presented during May, 2009, in Miles City, MT.  Representatives from each of the four rural towns (N=12) attended with the intent that the newly-trained participants would return to their communities to host six-week caregiver training for ten to twenty local individuals.  Two trained leaders, Dr. Sandra Bailey and Jennifer Wells, facilitated the group and provided attendees with a detailed script and other materials needed to lead a class.  To evaluate the effectiveness of the training, the standard post workshop evaluation consisting of 17 scaled items was used.  On a scale of 1 “Strongly Disagree” to 4 “Strongly Agree,” the result was a mean score of 3.33 or above for each of the items.  The items with the strongest rating included:  understanding emotions, ways to care for my own health, having an identity outside of caregiving, knowing how to handle discouragement, knowing ways of coping with stress, and ability to make decisions about caregiving.  These understandings and abilities were critical for caregivers, and it was rewarding to see the positive response to the workshop.  Areas that most participants identified as needing more attention were ‘how to assert one’s self in meeting own needs,’ and ‘lack of confidence in knowing the materials well enough to offer the class.’  These findings were closely aligned with the results from similar Powerful Tools for Caregivers workshops that had been conducted across the state

HERE Project Description – Year 02
The second year of the HERE project began in September 2009, funded by a no-cost extension on the USDA grant and with supplemental funding from the NN/LM PNR to start in January 2010.  In October 2009, Drs. Weinert and Young traveled to each of the four small rural communities and held Town Hall meetings to provide a summary of the first year activities.  Attendees at the Town Hall meeting were provided with a list of the titles and the schedule of the five health literacy enhancement monthly webinars scheduled for 2010.  Seniors who had not participated in the My Health Companion © portion of the project in the first year were given the opportunity to participate this year.

Dr. Clarann Weinert

Clarann Weinert, SC, PhD, RN, FAAN

Principal Investigator
Montana State University
College of Nursing
cweinert@montana.edu




Dave Young

Co-Investigator
Montana State University
Extension Service
dyoung@montana.edu

Sandra Baily

Co-Investigator
Montana State University
College of Health and Human Development
baileys@montana.edu

Gail Kouame

Co-Investigator
National Network of Libraries of Medicine
Pacific Northwest Region
Seattle, WA
gmarie@u.washington.edu