Targeted community outreach events to deliver healthcare to diverse rural populations

Introduction: Rural populations often experience disparities in health and access to and quality of healthcare. Such disparities may differ among subpopulations. Community outreach events provide an opportunity for rural residents to receive health services and education at reduced or no cost. This project builds on our previous experience with community health fairs by providing health events that target specific underserved subpopulations (rural youth, Latinas, and men).

Methods: Our first event provided free sports physicals to area students. The second provided free health screenings to men during an annual agricultural event (Bean Day). The third was a cardiovascular health event for Latinas that featured free or reduced cost health screenings and other health-related and culturally appropriate activities.

Results: Thirty-five students received sports physicals, enabling them to participate in sports. Twenty-two Bean Day participants, primarily men, received health screenings; four were hypertensive, three were overweight, and 12 were obese. Over 100 women attended Latina Red Dress and received health services and education. For many in these subpopulations, events such as this provide the only healthcare they receive. During all three events, participants received education regarding any health issues of concern and referrals to local health clinics when appropriate (e.g. hypertension, high glucose levels).

Conclusion: Community health events such as these provide culturally appropriate and economical means to deliver health services and education, enabling participants to identify and address any health concerns. Targeting events for underserved subpopulations helped engage them in their healthcare. These findings support the need for effective education and intervention efforts to address physical and mental health concerns in this rural area. This was our first contact with these particular populations whom we know need intervention to receive health care. Moving forward through 2020 and beyond we will have future health fairs in the same groups in order to assess if the health fairs are indeed impacting health of these children, men and minority women.

Access to and quality of healthcare vary among populations and are influenced by many factors including race and ethnicity, socioeconomic factors (e.g. income, insurance status), personal attributes (e.g. age, sex, disability status, sexual orientation, gender identity), and where people live (Agency for Healthcare Research and Quality, 2019) [1]. The outreach efforts reported here primarily addressed health disparities related to rural residence, though this interacted with other factors listed above as well.

Populations in rural areas often have poorer health measures than those in urban areas [2-4]and access to healthcare continues to be a top concern for rural residents [5]. Shortages of providers and healthcare services are common in rural areas and contribute to health disparities [6-8]. Other factors affecting access to healthcare in rural areas include distance to services, transportation difficulties (e.g. availability of transportation/driver’s license, impact of weather, time constraints), financial constraints (e.g. poverty, insurance), and lack of broadband internet services [8]. Other factors contributing to health disparities relate to cultural norms and coping behaviors (e.g. concern about stigma and confidentiality, foregoing or delaying care as long as possible, use of emergency care rather than routine care) [8]. Additionally, when healthcare services are available, individuals may be reluctant to access services if they do not feel comfortable with the provider or the cost is prohibitive.

We have often used community health fairs to provide free or low cost health services and education to underserved rural populations [9-12]. Based on findings from previous community outreach efforts, we identified three subpopulations as needing focused outreach to engage them in health services. Therefore, we conducted three community outreach events specifically targeting rural youth, Latinas, and men. Data collected during these outreach events provide insights into the health status of these subpopulations that can guide interventions and future health services outreach. As we move forward into the next few years, we will continue to gather data in order to determine the effectiveness of the health fairs on participants health and report it through future publications.

These outreach events were made possible through the collaborative efforts of our team which included a DNP mental health provider, pediatric nurse practitioner, nurse researcher, and undergraduate and graduate nursing students. The purpose of these outreach events was to provide health services and education, not research, therefore, no health history or sociodemographic data were collected. Residents of the rural Nebraska city and county where these events were held were primarily non-Hispanic white (62.8% city, 71.6% county) or Latino (32.0% city, 24.3% county), with 18% and 14.3%, respectively, having income below the poverty level [13].

Youth sports screenings

We provided free sports physicals to area students August 14, 2019 from 3:00 to 7:00 PM in a community meeting room at a local community college. Written parental/guardian permission was required for each student participating. Exams covered all body systems as detailed on a standard physical form or the form provided by the student’s school. A certified pediatric nurse practitioner reviewed the results of each exam and discussed any areas any areas of concern with the parent/guardian and student.

Men’s health screenings

February 11, 2020, we collaborated with the Nebraska Dry Bean Growers Association to provide free health screenings (blood pressure, blood glucose, body composition) to rural men during their annual Bean Day. Participating in this agricultural event, attended by bean farmers from throughout the Nebraska Panhandle, enabled us to provide health services to a population that rarely seeks medical care or receives preventative care. Team members discussed screening results with participants and referred those with concerning results to appropriate care.

Latina red dress

Latina Red Dress, a cardiovascular health event for rural Latina women, was held February 15, 2020 from 8:00 AM to 3:00 PM at a local event center. Planning began 7 months prior to the event and involved members of the Latino community, staff from the Community Action Partnership of Western Nebraska, and members of our team. A key feature of this event was offering free health screenings and education (blood pressure, blood glucose, body composition, hearing, anxiety, depression, dementia, medication reviews, dental hygiene, physical therapy, chiropractic care) and reduced cost ($38.15) blood draws throughout the morning. The focus on health continued with a heart-healthy lunch, heart health and motivational presentations, and a fashion show featuring Latinas who have overcome chronic health conditionsand are leading healthier lives as the models. To accommodate language preferences, speakers and emcees were bilingual, interpreters were available throughout the event, and written materials were available in both Spanish and English. The event also included local vendors and traditional music and dance performances.

Youth sports screenings

Holding the event after school and into the evening hours enabled families with working parents to participate. Providing these services without cost relieved the financial burden for those with lower incomes. This event occurred shortly before the deadline to submit sports physical documentation and provided a last chance opportunity for many of these students. Thirty-five students from throughout the county received physicals during the event. Encouraging an active lifestyle by enabling students to participate in sports is important in this rural area, which has high levels of obesity. Families were very appreciative and strongly urged us to hold the event next year.

Men’s health screenings

Participating in this agricultural event, attended by growers and others in the dry bean industry, enabled us to provide health services to a population that rarely seeks medical care or receives preventative care. We provided screenings for 22 participants. Four were hypertensive and referred to a local clinic. Body composition analysis revealed that 12 participants were obese and three were overweight. We provided education and encouraged them to increase their hydration. Organizers and participants were appreciative of the health screenings and encouraged us to participate next year, which we intend to in order to gain follow up data on health conditions.

Latina red dress

Over 100 women attended Latina Red Dress. Though they enjoyed the social aspects of this event, the focus was on providing health services and education. The health fair booths received steady business and for many of these women, events such as this provide the only healthcare they receive. Data showed that there is a relatively high incidence of hypertension, overweight and obesity in this group, as well as great need for mental health services. Evaluations of the event were very positive. Participants appreciated the language accommodations (bilingual speakers, interpreters, etc.) and the information and services they received. Many expressed that they would bring more friends and family to the event next year. The experiences and relationships developed through planning and conducting Latina Red Dress laid a strong foundation that will enhance future work on this and other events in the Latino community.

Community health events such as these provide culturally appropriate and economical means to deliver health services and education, enabling participants to identify and address any health concerns. These findings support the need for effective education and intervention efforts to address physical and mental health concerns in this rural area. These events also provided valuable learning experiences for local nursing students, many of whom will practice in this rural area in the future. Our outreach team will continue to build upon these community events to provide health services and education to these and other subpopulations within this rural area.

We thank the UNMC Nursing Students who performed the health screenings and educational interventions.

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