Macon County Public Health’s Strategic Planning to Address Overweight & Obesity Involves Key Stakeholders

Erin Braasch and Lyndsey Henderson

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

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 and Lyndsey Henderson

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.”

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.

Image by Nik Shuliahin

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

Photo of Graham County by Patrick Williams, Ecocline Photography

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 (emily.kujawa@wnchn.org).

WNC Health Network is proud to have created a suite of materials to help our WNC Healthy Impact partners communicate with local stakeholders about their community health assessment process, including a short video about the CHA process and WNC Healthy Impact partnership in WNC:

Please feel free to share this video with others – whether in a community presentation or on your Facebook page. Community health assessment can feel complex, but this video helps break down the process and the partners that have helped make western North Carolina a leader in collaborative community health improvement.

 

Community Health Assessment in Western North Carolina (Script)

For more than twenty years, WNC Health Network has been the non-profit alliance of hospitals in Western North Carolina. Our hospitals have a long history of working together to create healthy, thriving communities throughout sixteen counties.

In 2011, our member hospitals joined together with all local public health agencies in the region to use data, relationships, and community voices to strengthen the health and wellbeing of all residents. We call this shared effort “WNC Healthy Impact,” and it has grown to become a nationally recognized model for community health improvement.

In western North Carolina, improving the community’s health is led locally by each unique hospital and public health partnership. WNC Healthy Impact leverages regional support to strengthen these local efforts. This drives measurable improvements to health.

How does an entire region work together like this? This cycle represents what we do at each step. Every three years, communities in western NC ask: How are we doing? What is the story behind the data? Who are the partners making a difference? What works to do better? And, what are we going to do now?

In the first phase, we focus on the facts by collecting and analyzing community data. We gather high-quality primary and secondary data that local communities can use for decision making. We then help communities dive deeper to listen and understand the story behind the numbers.With this data in hand, each local community decides what’s most important to act on. They engage a broad range of stakeholders to narrow their priority health issues.

Once priorities are set, local stakeholders decide what works to do better. Together, diverse partners lay out the right mix of solutions to make a measurable difference to community health. Throughout this process, peers join at a regional level through WNC Healthy Impact to ensure collaborative growth and excellence.

In the final phase of the cycle, communities take action on strategies they have chosen. As local leaders and residents work to make a collective impact, WNC Healthy Impact helps them measure the progress being made. This enables stakeholders to evaluate health improvement, hold themselves accountable, and be transparent about what’s working.

By working together, our hospitals and public health agencies are truly creating healthy and thriving communities in western North Carolina. Learn more and connect with us at www.wnchn.org.