Performing Department
(N/A)
Non Technical Summary
New York State has a large rural and socially vulnerable population. Age-adjusted mortality rates are 20% higher for rural Americans, influenced by the social and structural determinants of health: lower education rates, higher poverty rates; limited access to health insurance, health care, and public health services; food deserts; and transportation barriers. To achieve health equity, rural communities need improved use of resources to prevent disease and reduce harm. This can be achieved when community capacities are leveraged for shared impact, facilitated by community-based public health workers via embedded, sustainable, culturally relevant programming. We propose a sustainable solution with cooperative extension offices at the core.In rural New York communities, cooperative extension office staff are trusted leaders who provide services, support education, and facilitate rural development. Many extension offices work to support the determinants of health, but staff are not fully equipped to engage in "public health" initiatives. We aim to change that.We will use active distance-learning to achieve four project objectives. Using the Public Health Essentials Training we will (1) build public health competence (health literacy) among inter-professional cooperative extension teams, helping develop their 'public health identities'; (2) facilitate development of coordinated public health improvement plans linked to existing county priorities; and (3) support planning to augment extension programming to reach underserved communities using seed-grants. Using developmental evaluation and outcomes evaluation, we will (4) monitor and improve processes to achieve program impacts: increased use of health promotion programs that support community health, wellbeing, and quality of life.
Animal Health Component
(N/A)
Research Effort Categories
Basic
(N/A)
Applied
(N/A)
Developmental
100%
Goals / Objectives
The overarching goal of this program is to improve rural community health and resiliencevia (i) building capacity among Cornell Cooperative Extension (CCEx) educators and their peers, (ii) helping them to build public health-related coalitions, and (iii) augment the public health focus and reach of evidence-based programs that (iv) improve the SDoH and use of prevention services that (v) positively impact county CHIP goals.Our work will be implemented in two phases: (1) capacity development + (2) capacity application.Year 1: Phase 1a - Capacity Development will occur over the first eight months of the program. The objectives are to (a) build collaborative public health-oriented strategy teams (PSTs) with CCEx at the core, and to (b) develop PSTs' capacity, both individual competence growth in key public health domains, and collective PST leadership growth. To achieve this, the Program Manager (PM) will build eightPSTsof ~five learners representing CCEx and other community providers (including RHN peers), in threeregional cohorts (hubs). The PST members (n=45) will be oriented to program goals and will complete the Public Health Essentials training, supported by routine meetings with thePM and regional Mentors.Phase 1b - Project Activation will occur in the final four months of Year 1. The PM and Mentors will help PSTs and/or regional hubs build from their course project assignmentsto develop and submit project proposals for a competitive seed grant to translate learning into action. Seed grants will provide fundsto catalyze collaboration and extend the reach of current CCEx project work, specifically to advance local CHIP goals.Year 2: Phase 2a - Integration & Capacity Application will occur over the remaining 24 months of the project. The Phase 2a Objectives are to help PSTs apply their developed public health capacity by (a) maintaining a community of practice, (b) engaging in community public health leadership activities, and (c) integrating the content and materials from the PHE training into their services by adapting program focus, modifying the delivery of materials/education and/or collaborating and building collective impact with new partners. With awarded seed grant support, PSTs will implement the ideas/plans developed in Phase 1, with support fromPM and Mentors (routine coaching calls).Working with the Evaluator, the PM will gather and document specific process-related data via the PSTs on a monthly basis to monitor progress, and to help see rapid cycle process improvement cycles. Quarterly, each region will receive a summary report, showing progress made and emergent themes, actions taken, populations reached, and outputs/outcomes to help augment awareness of peer PST's contribution to community health, to spur adaptation and improvement, and to foster deeper collaboration and coordination.Year 3: Phase 2b - Outcome Evaluation. Phase 2a will continue into Year 3 as PST members work to support overall health improvement. However, in the last six months of Year 3, the Evaluator will build on the process evaluation to conduct an end of program evaluation. The Phase 2b objectives are to document (a) reach of the RHSE 2023 program, (b) aims, and (c) of outcomes of the PST-led projects.
Project Methods
Using non-traditional distance education and mentoring, we aim to increase rural public health capacity, reach, and impacts by integrating cooperative extension into community health improvement activities.Our underlying Theoretical Framework integrates four theories:(1) Factors to Facilitate Community-led Actions for Sustained Impact posits that community engagement and development can address complex issues: community engagement identifies issues, assets, and a vision; community development builds on assets to facilitate leaders who enable collaborative processes; systems change occurs as these leaders adapt policies, structures, processes, and systems to improve access to health; and leaders support this via communication, patience, passion, and change management. Our intervention capacitates CCEx educators and their PST partners to be these leaders of change.(2) Andragogy Theory posits that adults learn best when it is self-directed, practical, and focused on problem-solving.Our evidence-based Public Health Essentials (PHE) training uses Andragogy. The 80-hour facilitated project-based curriculum equips learners with the foundations of public health so they can better serve as CHWs.The training helps learners explore the public health approach and methods; the health and demographic status of their community; and the resources to build upon to close health gaps. With mentoring, learners complete projects that are locally relevant. Using PHE, our intervention equips learners to engage with vulnerable populations, collaborate with existing programs, work with community gatekeepers, expand education outreach, and contribute to CHIP goals. (3) The Integrated Model of Behavior Prediction (IMBP) is a part of PHE, and the mentoring approach used. IMBP posits that knowledge alone does not predict behavior change, but rather attitudes, beliefs, self-efficacy, and removing environmental and structural barriers.Our intervention focuses on mentoring PSTs to overcome barriers, and to engage their communities in doing the same. Specifically, PSTs integrate their new capacity into their exiting work to expand reach and influence health promotion behaviors.(4) Finally, the Diffusion of Innovation Theory informs long-term sustainability of this approach, as new ideas and actions spread as early adopters generate data and outcomes to engage and inspire others. By working with the CCEx network, and their rural community partners, this approach has the potential to be disseminated statewide, or even throughout the national extension network.Process and outcomes evaluation methods will be used to document the reach of the RHSE 2023 program. Data will be collected via surveys (to assess change learner capacity, and explore how that capacity is applied for public health improvement), document reviews (Phase 1a plans/proposals and Phase 2a process evaluation notes to understand the aims, activities, outputs, and outcomes of the seed grant activities), implementation team focus groups interviews (to add details and richness to the strategies and tactics used, and the facilitators and barriers faced in seeking to augment public health outcomes), and key informant interviewswith county public health officials and RHN leads (to understand the impact of this program on the local PHW reach and capacity to improve public health).