Effectiveness of community health workers in providing outreach and education for colorectal cancer screening in Appalachian Kentucky.

The purpose of this study was to examine the effectiveness of a community health worker (CHW)-delivered cancer education program designed to increase knowledge and awareness of colorectal cancer screening options. The study population was an extremely vulnerable and medically underserved geographic region in Appalachian Kentucky. CHWs enrolled participants in face-to-face visits, obtained informed consent, and administered a baseline assessment of knowledge of colorectal cancer risks and the benefits of screening and screening history. An educational intervention was then provided and participants were re-contacted 6 months later when a posttest was administered. The mean score of the 637 participants increased from 4.27 at baseline to 4.57 at follow-up (p < .001). Participants who reported asking their health care provider about colorectal cancer screening increased from 27.6% at baseline to 34.1% at follow-up (p = .013). Results suggest that CHWs were very effective at maintaining the study population; no loss to follow-up occurred. The results also showed increased knowledge and awareness about colorectal cancer screening education. Implications for social work practice, policy and research are discussed.

Rural-urban differences in health insurance coverage and patterns among working-age adults in Kentucky.

CONTEXT: Past studies show that rural populations are less likely than urban populations to have health insurance coverage, which may severely limit their access to needed health services. PURPOSE: To examine rural-urban differences in various aspects of health insurance coverage among working-age adults in Kentucky. METHODS: Data are from a household survey conducted in Kentucky in 2005. The respondents include 2,036 individuals ages 18-64. Bivariate analyses were used to compare the rural-urban differences in health insurance coverage by individual characteristics. Logistic regression analyses were used to examine the independent impact of rural-urban residence on the various aspects of health insurance coverage, while controlling for the individuals' health status and sociodemographic characteristics. FINDINGS: The overall rate of working-age adults with health insurance did not differ significantly between the rural and urban areas of Kentucky. However, there were significant rural-urban differences in insurance for specific types of health care and in patterns of insurance coverage. Rural adults were less likely than urban adults to have coverage for vision care, dental care, mental health care, and drug abuse treatment. Rural adults were also less likely to obtain insurance through employment, and their current insurance coverage was, on average, of shorter duration than that of urban adults. CONCLUSIONS: In Kentucky, the overall health insurance rate of working-age adults is influenced more by employment status and income than by whether these individuals reside in rural or urban areas. However, coverage for specific types of care, and coverage patterns, differ significantly by place of residence.

Increasing the medical school applicant pool: a key to training more rural physicians.

CONTEXT: Workforce studies show shortages of physicians in many areas of the United States. These shortages are especially severe in states such as Kentucky with many rural counties and are predicted to worsen in the future unless there are changes throughout our educational system to build aspirations and prepare students for medical school education. PURPOSE: To examine rural-urban differences and community characteristics of applicants and matriculants to Kentucky's two allopathic medical schools and influences on the educational aspirations of young students who wish to become physicians. METHODS: The number of Kentucky applicants and matriculants to allopathic medical schools was obtained from the Association of American Medical College's data warehouse for the period from 2002-2006. A continuous, multidimensional measure was used to classify counties by degree of rurality. Socio-demographic variables were selected for the counties of residence for applicants and matriculants. Model variables were tested in a least squares multiple regression model for their ability to explain patterns among Kentucky's 120 counties in the number of both resident applicants and matriculants to medical school. Data from a survey of middle school participants in summer health camps were analyzed to help identify important influences on young students aspiring to a career as a health professional, especially becoming a physician, and how these might be supported to increase the supply of rural medical school applicants. FINDINGS: The low number of rural applicants to medical school was highly correlated with the relative rurality of their county of residence, a low physician-to-population ratio and a low number of total primary care physicians. The percentage of county residents having a bachelor's degree level of education or higher had a positive impact on the application rate. Respondents became interested in health careers at age 15 or younger, and parents and grandparents, teachers, and close associates stimulated their aspirations, with teachers being the most influential. CONCLUSIONS: Prospective students respond to their perception of need for physicians. Rural students are influenced by those who are more highly educated. To overcome the shortage of physicians in rural communities efforts must be made to increase the aspirations for medical education of prospective students from rural counties.

Kentucky Homeplace Defeat Diabetes Screening Test: an analysis of rural Kentucky's challenge to overcome the growing diabetes epidemic.

The University of Kentucky Center for Rural Health original research note, "Kentucky Homeplace Defeat Diabetes Screening Test: An Analysis of Rural Kentucky's Challenge to Overcome the Growing Diabetes Epidemic," provides the results of a yearlong diabetes risk survey that included more than 3,000 participants in rural Kentucky. It is well known that diabetes poses serious health threats across our country. For various reasons, that is especially true in Kentucky, with rural Kentucky having the highest prevalence for the disease. From September 2002 through August 2003, lay health workers with the nationally recognized Kentucky Homeplace program distributed and processed 3,092 diabetes self-test surveys to their clients across five regions of the state to get a better picture of the diabetes epidemic. The screening test was developed as an educational and public awareness tool by the Defeat Diabetes Foundation Inc, a nonprofit organization based in Madeira Beach, FL. It was distributed to various health agencies across the country. Each survey contained 16 questions, ranging from determining participants' urinary frequency and family medical history to their age and weight. Zero, five, or 10 points were allotted depending on respondents' degree of incidence for each question. A score of 0-15 points suggested a low risk for having diabetes, 20-25 points suggested that a respondent was at medium risk and should be tested for the disease, and a score of 30 points or higher suggested that he/she was at very high risk and "should seek (a) medical evaluation right away." Several months of analysis of the data collected indicated that 74.6% of the Kentucky Homeplace clients who participated in the survey were at moderate to significant risk of having or developing diabetes, a much higher rate than the approximately 50% of Kentucky adults in the general population that previous studies indicated were at risk. While findings from the survey of more than 3,000 Kentucky Homeplace clients cannot be generalized to Kentucky's population as a whole, they further confirm other evidence indicating that diabetes will continue to be one of the most serious health threats facing the state's rural populations. The research note further offered some recommendations for curbing rural Kentucky's diabetes epidemic, including increasing the number of certified diabetes educators serving rural Kentucky, expanding lay health worker programs within the rural portions of the Commonwealth, and studying the method and effectiveness of diabetes education between physicians and patients.