Macon County Public Health’s Strategic Planning to Address Overweight & Obesity Involves Key Stakeholders
In the current community health assessment (CHA) cycle, Macon County in western North Carolina identified “overweight and obesity” as one of its four health priority areas because it is a common risk factor for many chronic diseases and is one of the biggest determinants of overall health status. Local survey data from 2018 shows that 68.3% of people in Macon County are overweight and obese.
Lyndsey Henderson, health educator with Macon County Public Health, is leading the process locally to develop an action plan to achieve the result: “Eating smart and being active is part of everyday life in Macon County.” To this end, Lyndsey has formed a work group that includes representatives from the local library, Angel Medical Center, Macon Program for Progress, NC Cooperative Extension, and other community groups and businesses.
Matt Bateman works at Franklin Health & Fitness, a local fitness center in Macon County. “Even though we’re private and for-profit, we have a duty to the community,” says Matt. “We can uniquely offer services to the community, whether it’s free or through scholarships, to aid this goal of eating smart and being active as part of everyday life.”
Workgroup member Amanda Pack is Clinical Nurse Director, Cardiac and Pulmonary Rehab with Angel Medical Center. “We’re focused on obesity’s connection to chronic health management and disease management – doing what we can do to help reduce risk factors and help people make a turnaround to improve their long-term health,” says Amanda. “I really want to promote knowledge of the resources that we already have, the benefits or consequences of our health and our weight, and to promote access for our community.”
Macon County has contracted with Erin Braasch from WNC Health Network to help facilitate their action planning process. For the first workgroup meeting, Lyndsey and Erin worked together to develop an agenda that would use the Results-Based Accountability (RBA) framework to guide the group through a conversation around overweight and obesity in Macon County– including what’s helping/hurting and the partners involved.
Amanda Pack from Angel Medical Center says: “It’s wonderful in this workgroup to have collaborations from so many different aspects of the community with representatives from so many different places. This whole task force has been a good utilization of everyone’s time; we’re all professionals, we’re all busy. The structure is to the point, but it also allows for people to collaborate and share ideas.”
“Using RBA set me up for success,” says Lyndsey. “The thing that I liked most about how it was structured is that we specifically set aside time to talk about what’s helping and hurting. It can be difficult when groups want to go straight to what’s wrong and what’s not working. When you talk about what’s helping you uncover great things happening in the community – great resources and great people. It’s an eye opener – that even though there might be a gap here, there’s also an abundance here.” Lyndsey adds: “The way that we did it left people motivated and energized. We didn’t leave on a negative note – everyone seemed motivated and inspired.”
The workgroup spent their second meeting on community health strategic planning, including identifying indicators, performance measures, and prioritizing their first action together.
Carol Pitts with the Macon County Cooperative Extension Service runs the youth 4H and is a nutrition educator in the school systems and in job corps. Her hope for the workgroup is that they can break down siloes within their community and that, “we can help each other and grow and be healthier and make those changes in our lifestyle. It’s not a weight loss challenge, it’s a lifestyle change we all need to make.”
Lyndsey is excited about the progress of the task force, and the potential for change that she can see. “I really believe the community health assessment is by the community and for the community. Having this group feel like they own this process and that these priorities are important for them and others in the community – that was my biggest goal in planning and organizing and getting geared up for this.”
WNC Health Network creates healthy and thriving communities by helping hospitals collaborate outside of their walls. And while community health assessments are a more public-facing way that we support this connectivity, Bug Club is another great way that hospitals work alongside each other in our region in the best interest of all of our residents.
What is now known as Bug Club was started in the 1980s by Janice Brown as an informal gathering of infection prevention and microbiology professionals in western North Carolina (WNC). Early members included Alta Wells, Janice Brown, Ruby Connor, Ron Ferrigno, and others.
Sue Ferrigno – a medical technologist with a BS in medical technology and an MA in medical biology – joined in 1988. WNC Health Network recently spoke with Sue Ferrigno, as well as current co-leaders Ivan Gowe and Corrianne Billings to learn more about the history of the Bug Club (housed under the umbrella of WNC Health Network since 2007), as well as why it’s so important.
How does Bug Club function?
The Association for Professionals in Infection Control and Epidemiology (APIC) is a national organization with chapters in every state. NC is divided into 11 zones, and WNC has zones 1 & 2. Bug Club is the NC APIC meeting of those two zones.
We want to have a unified infection prevention program in WNC, so the community is receiving consistent messages. Bug Club is a place where we can bring up and share practices that we feel should be adopted regionally.
Representatives from hospitals and health departments in the region are invited, and about 15 people attend. We meet every other month, usually over lunch. We have time for new happenings, and for anyone who wants to share information they learned at recent conferences. There’s usually a topic of conversation – for example, at the last meeting two people reviewed journal articles with the group. It was a controversial topic so it was good to hear the latest published information. There’s time for networking, which is very important. Sometimes people come primarily to meet other peers, to find out how others are doing things.
What is an example of how Bug Club helped unified infection prevention in the region?
When the antimicrobial hand soap, triclosan, first started being linked with safety risks we discussed it at Bug Club,
and hospitals stopped using hand soap that contained it. In the high risk areas they use more potent hand soaps – so that’s good too. We try to aim for uniform practice.
How did Bug Club come to be part of WNC Health Network?
In the mid-2000s the hospital CEOs part of WNC Health Network came to Bug Club and asked if we could give them comparable infection rates for their hospitals.
Infection prevention has to report their data to the CDC’s National Healthcare Safety Network; they get every hospital’s data on infection, including surgical site infections, MRSA (Methicillin Resistant S. aureus) blood stream infections, catheter-related urinary tract infections, catheter related bloodstream infections, and Clostridioides difficile. Reportable conditions are benchmarked both state wide and nation-wide and are all compared based on the size and type of hospital. In 2009 that data started being reported through the state, so there was no longer a need to report back to the CEOs of the hospitals in WNC.
That was our first interaction with WNC Health Network – the request for our infection rate data. After that we had this relationship with the organization.
How do hospitals and public health agencies work together when it comes to infection prevention?
Open communication between hospitals and health departments is very important.
For example, at the hospital we might get a call from a family member saying – my child’s classmate has meningitis – do we need to get an antibiotic? And we know that the child is at Mission. There are a lot of privacy HIPAA rules, but if someone has a communicable disease that’s reportable the hospital must report it to the health department to help prevent further spread of the disease.
Hospitals and public health agencies work together to prevent and control transmissible diseases in our communities. If a child has meningitis diagnosed at the hospital, that information is relayed to the local health department. They follow up with the school and the family to reduce the impact of that very contagious disease in the child’s community. Bug Club is one of the few places that hospital and public health based infection preventionists can meet to discuss their work, its challenges and how to continue to provide the best care to the communities we serve.
Sue, you’re retired now – why do you still take the time to participate in Bug Club?
I really enjoyed doing what I did in my career. I feel infection prevention does have a large effect on improving health care, and Bug Club is helping with that.
How can others get involved with or learn more about Bug Club?
Professionals responsible for infection prevention at their hospital or public health agency are welcome to Bug Club – to RSVP for an upcoming meeting contact firstname.lastname@example.org.
By Nelle Gregory, RN, MPH
Many chronic health conditions and most dental diseases are preventable if we eat healthy foods, exercise, get good sleep, limit our stress, and practice good oral hygiene. Many of us have the information we need to make good decisions, so why do we sometimes
fail to follow our healthcare providers’ recommendations? To make changes in our behaviors, we must have the desire to act and move towards a goal…we must be motivated. For healthcare providers, it can be discouraging when patients fail to comply with their treatment recommendations. Research has shown that most of us have a hard time following our healthcare provider’s recommendations; knowledge is not enough to change behavior. It requires that healthcare providers move from simply sharing health information to building mutual respect that allows the patient to articulate his or her own solutions.
At community listening sessions conducted by The WNC Children’s Oral Health Initiative, parents said they do not know what good oral health looks like, when they should take their child to the dentist, where they could get care, what the standard care is, and how much it should cost. They do not have the basic information they need to make good oral health decisions… and it is impacting their ability to get their children into care. Many parents shared stories of feeling shamed and talked about being ‘blamed for their kids poor oral health.’ They discussed how this made them less likely to want to go back to the dentist.
The American Dental Association (Health Literacy in Dentistry, 2009) encourages the creation of a respectful and ‘shame-free’ dental environment. By helping patients identify their own reasons to change their behavior, they build trust in and respect for their healthcare provider and are more motivated to change. Motivational interviewing is one tool that helps healthcare providers support and encourage their patients’ readiness to change.
Motivational Interviewing (MI)
Motivational interviewing (MI) is an evidence-based approach to behavior change that is grounded in a respectful conversation between provider and patient to identify a patient’s readiness for change, and that helps the patient come up with ideas about how they can strengthen their motivation to change. Making MI the foundation of anticipatory guidance assures that providers listen to the concerns of parents and children, understand their ambivalence to change, and support their ideas about change and what they think would work. In a dental setting, MI shifts the conversation from a one-way monologue about brushing their teeth and cutting down on sugar to a conversation about the parent and child’s experiences, challenges, and ideas about what needs to change and how the provider can support them in making the needed changes.
The American Dental Association research has shown that the main reason people do not get dental treatment is due to cost and perceived need. The way providers counsel impacts their patients’ perceived needs. At one of the community listening sessions a parent shared that her dentist told her to ‘just do a better job brushing her daughter’s teeth,’ but the parent, whose child is autistic, said that she has a hard time getting her daughter to open her mouth, and brushing her teeth is the least of her worries. She left frustrated that her dentist had no understanding of autism, and her perceived need for dental services was low.
Research has shown that using MI in dentistry can lead to more lasting behavior change and improved oral health outcomes (Kay, 2016). Positive behavior change occurs more readily when healthcare providers connect the change with what the patient values – people are motivated to change when it impacts what they value rather than what someone else determines they need. Confrontational styles or persuasion are likely to build resistance and mistrust. When health providers try to persuade or give advice, patients often feel guilt or shame. Healthcare providers must abandon the impulse to solve their patient’s problems and allow them to articulate their own solutions. Our motivation is impacted by our culture, family norms, and the multitude of other issues we deal with in our daily lives. The parent of the autistic child shared that she just needed her dentist to listen to her, hear the challenges she faces when trying to care for her daughter’s oral health, empathize with her, give her suggestions the dentist had heard from other autistic parents on how to get her daughter to open her mouth, and work with her to figure out a better solution.
The WNC Children’s Oral Health Initiative is partnering with MAHEC to develop MI training for dental professionals. If you want to get more information about the project or MI training, contact email@example.com.
About the WNC Children’s Oral Health Initiative
The Western North Carolina (WNC) Children’s Oral Health Initiative, with funding from The Duke Endowment, is working to improve children’s oral health. The project is coordinated by Mission Children’s Hospital and WNC Health Network and overseen by a Steering Committee of dentists, dental hygienists, physicians, public health providers, and community partners. The group completed an assessment of children’s oral health in 18 western counties in NC in 2017. They held parent listening sessions to hear concerns parents in WNC had about their children’s oral health. A strategic plan was developed that prioritized the concerns voiced by parents.
American Dental Association. Health Literacy in Dentistry: Strategic Action Plan 2010-2015. Council on Access, Prevention, and Interprofessional Relations. Chicago, IL, 2009.
Achison KA, Rozier RG, Weintraub JA. Integrating Oral Health, Primary Care, and Health Literacy: Considerations for Health Professionals Practice, Education and Policy. Commissioned by the Roundtable on Health Literacy, Health, and Medicine Division, the National Academies of Sciences, Engineering, and Medicine. Prepublication copy, 2018.
Kay EJ, Vascott D, Hocking A, Nield H. Motivational interviewing in general dental practice: A review of the evidence. British Dental Journal 2016; 221: 785-791
Beth Booth, originally from the coast of NC, became health director of Graham County, NC in November, 2017. Since landing in her leadership role with Graham County Department of Public Health, she has led the agency in bringing back primary care and in streamlining services, working creatively to leverage auxiliary and support staff in the face of a rural nursing shortage.
The health department is also strengthening their work in the community and has reestablished a previously dormant substance use coalition. In addition to Beth and Amber Williams, Health Educator at the health department, the coalition includes resource officers, principals, preachers, nonprofit leaders, the leader of Celebrate Recovery (a local faith-based recovery program), and the director of a local thrift store who is a minister and does work with substance use.
As Beth was getting the coalition back in action, she determined that she wanted to conduct a listening session (or focus group), with people in recovery to both help inform the community health assessment process, and to also avoid taking on issues not viewed as high priority by those most affected by substance abuse.
Beth and Amber worked with WNC Health Network before the listening session. “Support from WNC Health Network was crucial,” says Beth. “We attended their WNC Healthy Impact training on how to convene community listening sessions. Then they worked with us
one-on-one to develop the script and give us pointers, including how to pay attention to body language of people in the group, how to ask people to speak up without being obtrusive, and how to sit quietly and not overpower the group or sway them in any direction.”
Beth had built a relationship over the previous year with a team leader at Celebrate Recovery, and he was able to schedule an evening for Beth and Amber to come to meet with participants in the program. Beth and Amber arrived early so that they could participate in the sermon and group dinner prior to their session. “I didn’t just walk in during the middle of the sermon and disturb everything. Staying for the whole event is crucial for building mutual trust and respect,” says Beth.
Beth and Amber started their listening session by letting participants know that the session would be recorded, and how they were planning to use the information. When the session started they had six participants – by the time it ended they had about 10 in attendance.
“I told the participants – you are the experts in this. I want to know what you’ve experienced, how you got where you are, and how you got yourself out,” says Beth. “At one point when our tape recorder stopped running the participants let us know that it had stopped and waited to continue talking until the recorder was running again. Oftentimes public health is afraid they’re going to offend someone by asking targeted questions, but it’s not a sensitive issue to them, it’s their life. They want you to hear what’s coming out of their mouth and to give a darn about what they think.”
The listening session participants gave Beth and Amber feedback on where to locate syringe drop boxes, and how to best structure youth prevention programming. They also spoke to the challenges posed by stigma: “The group told me that there are plenty of people who have trouble getting help because people don’t think they’re worth the help.” Eventually, the team leader had to come in and stop the lively session because it was past 9 pm.
Because of feedback and insights gained from the listening session, the health department is now working on reopening the domestic violence shelter that shut down in 2017. They are exploring what can be done to expand transitional housing, and to increase prevention for youth, including resiliency education in the schools. They are looking at starting a support group for adults in recovery that is not faith-based, as well a support group for children located in the schools.
The experience – in addition to holding listening sessions with other segments of the community – has driven home for Beth that there are still too many people who don’t realize what a huge problem substance misuse poses for their friends, family, and neighbors. Beth says: “That has been an awakening for me – I took it for granted that people knew we have a problem in our county, but when I present the data and the stories I’ve heard you can hear the murmur going through the room… they’re shocked. It has started coming down to community-wide education and bringing everyone to realize, yes – there’s a problem in the county. It might not touch you, but it exists.”
Beth Booth’s Thoughts on Successful Listening Sessions:
- Be upfront when you go in to the listening session; know that participants are going to ask you what you plan to do with the information and that you will be held accountable for how you respond.
- Don’t make assumptions; sit and listen with an open mind.
- Don’t think that participants are going to be close-lipped. If you build relationships and mutual respect they will respond to your questions openly and generously.
- Be honest about what you’re looking for: ‘I’m here for you and your opinion.’
- Let the group know that they are the experts and that you’re looking to learn from them.
- Take the time to sit through the entire session or event (provided that you have been invited into that space). Be respectful of the participants’ time and the time you’re taking from them.
- Take the information given to you by the participants and understand that their story is valid data, as if you had asked a scientist.
- When you acquire information from community members you must hear it and you must do something with it – you’re responsible for it.
- Understand that the participants have just as much passion about the issue as public health does – probably even more passion.
If you are interested in learning how WNC Health Network could support you in conducting community listening sessions of your own, contact Emily Kujawa, Project Manager & Improvement Specialist (firstname.lastname@example.org).
The new Journal of Appalachian Health was created through a collaborative effort between several academic institutions and organizations located within the Appalachian region. The journal is an online, open access, peer-reviewed journal with a mission of creating a healthy and thriving Appalachia.
Marian Arledge, executive director of WNC Health Network, is pleased to represent the organization on the advisory board of the journal.
The mission of the journal is to publish research findings capable of transforming policy and practice in a rapid, yet rigorous, process. Committed to highlighting relevant, local innovations developed in the Appalachian region, the editors would like to bridge community narratives with academic research.
Editorial and advisory board members envision a journal that will be inclusive and promote equity by engaging regional stakeholders in the development of the publication. Many of the articles will include commentaries that will highlight the implications of the research. The journal welcomes readers who will use the published findings in both the health and non-healthcare fields in which they work to affect change in their communities.
“We are very excited to launch this new journal as a hub for community and academic research in Appalachia. We anticipate that the journal will foster new research collaborations that will ultimately improve the health of the region,” said Dr. Erin Haynes, senior associate editor.
Authors interested in submitting articles for publication in the journal may follow the instructions located via the links provided on the website. Those interested in subscribing may follow instructions provided on the website to join the mailing list, connect with the journal via Twitter or contact the editors via email.