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The UCHAT Project

 

Unlocking Community Health Access Together

Nature of Problem

Unlocking Community Health Access Together,” directly addresses the Rural Health Issues Grand Challenge while also addressing the Public Trust in Research and Information and Quality of Democracy and Equality challenges. Wyoming is a highly rural and frontier state facing unique challenges to overcome disparities in access to healthcare. Wyoming has high rates of substance abuse, the highest rate of suicide in the nation, and the sixth highest rate of low birthweights in the nation (National Center for Health Statistics, 2020). These health challenges are coupled with costly air ambulance transportation (Parks, 2018), financial barriers to healthcare (Klamann, 2019), and community barriers to health, including public attitudes, social and economic factors, and a lack of a community connection (Wyoming Department of Health, 2018). The Department of Health (WDH) has worked collaboratively with partners and communities to establish priorities for the State Health Improvement Plan (SHIP), access to healthcare being one of them. To effectively address priority issues, we recognize the diversity of demographic and socioeconomic groups in Wyoming likely translates into differing values and goals as well as reliance on differing sources and forms of healthcare information. The foundation of any possible consensus thus becomes precarious unless an inclusive deliberative process allows stakeholders to not only identify collective similarities but also recognize the introspective formative process through which they and others develop their own knowledge, preferences, and opinions (Saltelli et al., 2020). Empirical evidence suggests such deliberative democratic processes lead to greater tolerance, broader program support, and greater understanding of one’s own, as well as others’, opinions (Kuyper, 2018). 

The primary goal of this planning grant project is to increase public engagement and deliberation in establishing common ground around strategies to address rural community health challenges. This proposal will lead to information dissemination and decision-making tools to assist local and state community health leaders in making informed and effective decisions revolving around healthcare access, investments, and planning. We will do this using a transdisciplinary approach drawing upon the University of Wyoming’s applied economists, health scientists, WWAMI (a multi-state medical education program), Extension educators, the Wyoming public, as well as extramural partners including WDH professionals and their SHIP steering committee. Through this transdisciplinary approach, we aim to build an inclusive coalition of stakeholders to address communities’ perceptions, concerns and visions in enhancing strategies to improve physical, financial, and social access to healthcare in Wyoming. We have identified three specific objectives to achieve this goal 1) identify barriers and strategies to increase public trust; 2) identify barriers and strategies to increase diverse public engagement; and 3) identify tools, programs, analyses, or data that will assist communities in achieving their local goals in a collaborative manner.

Team Members

Anders Van Sandt, PhD – Asst. Prof. in Agricultural & Applied Economics, Community Development Extension Specialist (avansand@uwyo.edu)

Juliet Daniels - Community Development Extension Field Educator (juliet.daniels@uwyo.edu)

Timothy Robinson, PhD - Dir. of WWAMI, Prof. in Mathematics & Statistics (tjrobin@uwyo.edu)

Mariah Ehmke, PhD – Assoc. Prof. in Agricultural & Applied Economics (mehmke@uwyo.edu)

Feliciana Turner – WDH-Public Health Division Performance Improvement Manager (feliciana.turner@wyo.gov)

 

Work Plan

            The first objective of this project will assess barriers and strategies to increase public trust through virtual roundtables and field interviews conducted by WWAMI medical students – Wyoming’s future physicians. The virtual public roundtables will use Zoom and Common Ground for Action, a public opinion and data collection software, to provide an accessible and constructive space for Wyomingites to share stories, rank issues, and work through a deliberation process to understand the drawbacks, tradeoffs, and compromises of health access strategies identified through the WDH’s SHIP efforts. This process will enable us to explore how public engagement builds trust in health information, the entities that create or distribute health information, and the different mediums through with the information is disseminated. In addition, the university community will be directly solicited to participate in the virtual roundtables and contribute ideas for strategies. This will not only strengthen the project through diverse academic perspectives, but also create greater opportunities for further collaboration.

Given our virtual roundtable findings, the investigators will target specific stakeholder groups by hiring student Field Moderators to assist in planning a deeper dive into local health issues to provide nuanced, on the ground, observations through intercept surveys, interviews, and/or listening sessions. These Field Moderators will be WWAMI medical students who are involved with the University of Wyoming Health Equity Circle student organization as part of their Rural Underserved Opportunity Program (RUOP) community health projects. Dr. Robinson directs the WWAMI medical education program at UW and will lead the organization of the student Field Moderators. The Field Moderators will participate in creating and informing the field activities, but the investigators will lead the local community member trainings, marketing activities, and other logistical efforts. This represents a dual opportunity to not only understand the nuances of underrepresented community health needs and concerns, but to also deepen future Wyoming physicians’ connection and understanding of the communities that they will ultimately serve.

The second objective is to identify barriers and strategies to increase the engagement of diverse groups in decision making and examine how engagement impacts trust in healthcare policies and governance. This will occur simultaneously with the first objective’s activities, specifically the utilization of the Common Ground for Action roundtables and local community follow-ups. Through this process we hope to explore how public engagement builds trust in policy making and how this trust is impacted by the ways public entities utilize stakeholder input. To increase stakeholder engagement, we will work with the WDH and its SHIP steering committee to identify communities that experience a greater burden or have a higher risk for experiencing access to healthcare issues. These groups will then be invited through targeted marketing activities to participate in the virtual roundtable sessions and WWAMI Field Moderator interviews. These marketing materials may include digital advertising, emails, and mail flyers and could be directed at state-wide groups or specific communities within the state.

The third objective of this planning grant is to identify tools, programs, analyses, or data that will assist communities achieve their local goals in a collaborative manner. This objective will be achieved by organizing data from the virtual deliberations and follow-up activities to develop unique community driven strategies and tools for greater local health access and equity. We will collaborate with our partners to ensure strategies and tools for specific stakeholder groups are developed in tandem to support a cohesive approach, employable at the state and community or group levels. Proposed outreach materials include online mapping-tools, Extension bulletins, industry listening sessions, educational programs on how to engage diverse audiences regarding health issues, and topic-specific webinars among others. WyGISC has offered to fund an undergraduate student pro bono to develop an online story map to disseminate initial findings and act as a proof of concept for future program development.

This planning project will culminate in at least one external grant submission exploring physical, financial, and social healthcare access issues across the US and over time to better inform community driven strategies. Dr. Van Sandt has identified an integrated Extension and research New Investigator grant RFA through the USDA that prioritizes rural communities, health, and outreach driven projects (due July 17th). This external grant proposal will utilize restricted federal administrative data to explore the health impacts of healthcare establishments beyond hospitals, including, urgent cares, non-employer physicians, mental health specialists, and ambulance services. The findings from this planning grant will serve as a guide for choice of statistical models, variables, and resultant tools or reports.

Partners

Extramural: WDH, Wyoming Rural and Frontier Health Unit, WDH SHIP Steering Committee

Intramural: WWAMI, Health Equity Circle, WyGISC, Extension, Agriculture and Applied Economics, Mathematics and Statistics (biostatistics), Electrical and Computer Engineering (Dr. Doman Novak)

Potential Granting Agencies: Agriculture and Food Research Initiative – USDA, NIH

Budget

Activity/Purpose

Amount

In-Kind

Integration of Common Ground for Action and Zoom

$10,000

 

5 Field Moderators (WWAMI-Health Equity Circle students)

$2,500

$15,000.00

Travel and conferences

$1,500

 

Spanish Speaking Roundtable Facilitators

$2,000

 

Marketing efforts for underrepresented groups/communities

$4,000

 

WyGISC Story Map

 

$2,000.00

UW AgEcon & Extension Personnel

 

$7,822.91

WDH Personnel & SHIP Steering Committee

 

$20,000.00

Total Amount Requested

$20,000

$44,822.91

 

References:

Klamann, S. (2019, June 10). Hospitals in Wyoming charging significantly more than Medicare, national study finds. Casper Star Tribune. https://trib.com/news/state-and-regional/govt-and-politics/health/hospitals-in-wyoming-charging-significantly-more-than-medicare-national-study-finds/article_0ee7ea88-0964-596c-8cfd-6581e726367a.html

Kuyper, J. W. (2018). The Instrumental Value of Deliberative Democracy – Or, do we have Good Reasons to be Deliberative Democrats? Journal of Public Deliberation, 14(1), 1–35. https://www.duo.uio.no/handle/10852/67168

Mosley, D., & DeBehnke, D. (2019). Rural Hospital Sustainability. https://www.navigant.com/-/media/www/site/insights/healthcare/2019/navigant-rural-hospital-analysis-22019.pdf

National Center for Health Statistics. (2020). Wyoming Key Health Indicators. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/pressroom/states/wyoming/wy.htm

Parks, T. (2018, December 5). AARP Releases Report Revealing Aging Wyoming Population. Outliers News, County 17. https://county17.com/2018/12/05/aarp-releases-report-revealing-aging-wyoming-population/

Saltelli, A., Bammer, G., Bruno, I., Charters, E., & Fiore, M. Di. (2020). Five ways to ensure that models serve society: a manifesto. Nature, 482–484. https://www.nature.com/articles/d41586-020-01812-9 

Wyoming Department of Health. (2018). State Health Assessment. https://drive.google.com/file/d/1SWbz827G77yDJqOzEgVFw9TgU7-2DjP1/view

 

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