Rural Health Activities Funded by CDC

The Arkansas Arthritis Program (AAP) is promoting and expanding lifestyle management programs like the Arthritis Foundation’s Walk With Ease program in rural areas. Rural training clinics and practices are introducing Walk With Ease group and self-led programs to promote and increase walking among adults with arthritis. Arkansas is a rural state, with 73 of its 75 counties considered medically underserved areas with health professional shortages.

Juniper^®, a program of Trellis™ is a network of 100+ community-based organizations and health systems. It supports the delivery of AAEBIs through its online Juniper platform, across rural and other areas of Minnesota by:

1. Promoting programs.
2. Offering online enrollment and referrals.
3. Supporting data management for AAEBI providers.
4. Connecting programs to sustainable reimbursement.

CDC Arthritis Program funds supported integration of WWE into the Juniper web-based platform, adoption of WWE by existing Trellis partners, and promotion of WWE. In 2021, Juniper and its network of community-based organizations supported the delivery of 26 WWE classes to 256 participants.

The Missouri Arthritis and Osteoporosis Program (MAOP) is partnering with organizations and health care providers to expand health services to diverse rural populations. In 2020, MAOP partnered with University of Missouri Extension to offer 20 new Walk With Ease (WWE) programs in 20 new rural sites and locations. The goal was to expand WWE programming in the southeast and southwest rural areas and underserved counties. These 20 new programs reached 297 new participants. Sixteen new leaders were trained during this time period who continue reaching these counties with programming and using word of mouth to reach new participants and raise awareness of the programs.

The New Hampshire Arthritis Program is partnering with organizations to promote and expand multiple arthritis-appropriate evidence-based interventions like Walk With Ease and the Chronic Disease Self-Management Program throughout the state, especially in underserved and rural areas. About 92.8% of the land in New Hampshire is designated as rural and about 39.7% of New Hampshire residents are currently living in a rural area. By using a combination of remote and in-person delivery of evidence-based interventions, partners have been able to address common barriers to participation experienced by rural and underserved populations, including access to transportation and travel distance. Since 2018, New Hampshire has seen year-on-year growth in the evidence-based interventions broadly available to New Hampshire residents, including those in rural and underserved communities.

Oregon Health Authority worked with The Oregon Extension for Community Healthcare Outcomes (ECHO) Network/Oregon Rural Practice-based Research Network (ORPRN), the Oregon Community Health Worker Association (ORCHWA), and Familias en Acción to develop a 12-session Community Health Worker (CHW) ECHO program. The program supports CHW champions in clinical sites to help primary care teams build their capacity to diagnose, treat, and manage patients with chronic diseases, including arthritis.

The ECHO audience includes CHW supervisors, clinicians, clinic managers, and others who can create the systems in which CHWs can help prevent and manage chronic disease. Two examples are increasing counseling for arthritis and physical activity and referrals to arthritis-appropriate evidence-based interventions (AAEBIs). The program will focus on social determinants of health, health equity, and culturally relevant and responsive services to meet broader community needs, improve outcomes, and increase connections to community resources.

ORPRN also offered a collaborative six-part learning series (webinars) to 48 rural health care providers. The webinars were paired with individual technical assistance from a practice enhancement coach to support quality improvement for rural clinics and health care providers to connect patients with AAEBIs and other chronic disease self-management programs and resources.

The Utah Department of Health and Human Services, Healthy Aging Program (HAP) is working with Intermountain Healthcare, the largest health system in Utah; Comagine Health, Utah’s quality improvement network/organization; and rural delivery partners to expand arthritis lifestyle management programs to rural and frontier counties in the state. HAP has been offering Chronic Disease Self-Management Education (CDSME/CDSMP) programs in these counties to strengthen infrastructure and help reduce disparities caused by the lack of program availability. Rural partners include

• • Cache County Senior Citizens Center in Logan.
  • Carbon Medical Services Association Inc. in Price.
  • Central Utah Public Health Department in the six-county area.
  • Five County Association of Governments in southwestern Utah.
  • Tooele County Health Department (offering the Arthritis Foundation Exercise Program (AFEP), CDSMP and Walk With Ease) in Tooele.

From July 1, 2018, to June 30, 2022, rural partners offered 49 AFEP workshops with 730 participants; 19 CDSMP workshops with 103 completers and 30 participants; 14 CDSMP workshops with 84 completers and 50 participants; and 18 WWE group-led workshops with 156 participants in 11 different counties. Many of the workshops were offered virtually for the first time in the history of the program.

The Washington State Department of Health (WA DOH) arthritis program will prioritize rural areas to identify and address barriers specific to those populations and expand arthritis lifestyle management programs throughout the state. WA DOH and their tribal and rural health partners will develop culturally specific communications in order to reach these underserved residents and enhance the arthritis program’s success and sustainability.