Rural communities across the United States continue to face health challenges and disparities, with higher percentages of preventable deaths, higher rates of Medicare and Medicaid populations and much fewer health care providers available to deliver health care. But addressing these issues can be a challenge because very little data has been gathered that sheds light on the health care and other health and wellness needs of rural residents.

Under the direction of Judy Johnston, M.S., RD/LD, a research instructor in the Department of Population Health at KU School of Medicine-Wichita, more rural Kansas counties are now getting important insight into not only the medical needs of their residents, but also other environmental and lifestyle factors that can influence their health and well-being.

“Community participatory research is what I really love,” said Johnston, who joined KU’s Department of Population Health in 2003. “I get to do the things I care about, and I just love the kind of work we’re doing.”

Johnston has overseen community surveys in six Kansas counties so far — starting with Kearny County in 2016, Haskell and Grant counties in 2017, and Thomas County in 2018. Her team conducted surveys in Wilson and Chase counties in 2019 and 2020. The community assessments have been funded by grants from a number of organizations, including the Kansas Department of Health and Environment’s Bureau of Family Health, Blue Cross Blue Shield of Kansas and Citizens Medical Center in Colby.

The idea of surveying rural residents on their health and wellness needs arose out of conversations between Johnston and Benjamin Anderson, who was then the president and CEO of Kearny County Hospital in Lakin, Kansas. Anderson reached out to Johnston in 2016 to help the hospital find out what Kearney County residents wanted from their health care system.

“Judy knows rural Kansas. She’s an engaging personality, extremely organized and understands the dynamics in rural Kansas,” Anderson said. “She shares our social conscience and our commitment to people who are vulnerable. When you have people who are motivated, things will happen.”

Initially, Anderson and the hospital wanted a better understanding of what led some of their patients to seek medical care in the emergency room when it could be more effectively provided elsewhere. Instead, Johnston convinced him that the survey should broaden to cover the many social factors that can influence health and well-being ― things such as availability of affordable childcare, quality of education, access to healthy foods, recreation opportunities and health ministry activities in faith communities, to name a few.

“I told him he needed to think bigger because health care is so much more than a health care system or provider,” Johnston said. “If you’re going to talk about health and wellness in Kearny County, the health care sector is a piece of that, but it’s there are so many other factors that contribute to a healthy life.”

Anderson agreed, so in 2016, Johnston created a survey for Kearney County. The survey asked questions to determine the level of knowledge residents have about existing programs in their communities, in addition to what other services and programs they would like to see.

A group of enthusiastic summer interns and community volunteers Johnston trained fanned across the county in 2016 to survey residents. Johnston said administering the surveys was definitely a team effort.

“We have been fortunate to work with individuals and agencies in every one of the six counties who know the counties better than I do,” Johnston said. “They have helped us identify volunteers we can train to administer the surveys.”

The surveyors were able to reach four out of five of Kearny County households ― 865 total ― an astounding 85% return rate on a survey. Johnston said the return rate in the other counties surveyed was almost as impressive, and she ended up with a 69% return rate among all six counties. Johnston said they were intent on making sure that all county residents had a chance to be part of the survey ― even undocumented immigrants.

“We knew there were some undocumented residents in Kearny, Haskell and Grant counties,” Johnston said. “We developed the surveys in English and Spanish, and we didn’t ask anyone if they were undocumented. I think that made them more likely to participate.”

The survey asked residents how they defined health and wellness. Was it just the absence of disease? Did it involve mental and social well-being as well as physical health? A second section drilled down and asked residents about resources the community had or needed in eight areas: health care, public health, early childcare and preschool, schools, faith communities, work sites, K-State Research & Extension at the county level, and the community at large. Finally, although the surveys were anonymous, it gathered household demographic information including race, ethnicity, age, employment, education and health insurance status.

The survey results revealed a need for better childcare, greater access to primary care, a desire for walking paths and other exercise possibilities, and a shortage of healthy food options, among other findings. But the needs of every county are different.

“For example, in Haskell County, affordable childcare located close to the county’s schools or the hospital was a priority,” Johnston said. “Thomas County residents want to make sure environmental monitoring of pesticide use and water quality were in place. In Wilson County, domestic violence resources were identified as a major need.”

Destany Wheeler, who serves as the chair for the Wilson County Wellness Coalition, said the initial survey of residents was eye-opening.

“Our survey participants identified a large number of priorities in every sector we asked them about,” Wheeler said. “First, it made us realize that many of our residents weren’t aware of the existing services available in Wilson County, and at the same time, it showed us we have gaps where we don’t have all of the services our residents need to live the healthiest lives possible.”

To dig deeper into the survey data, Johnston worked with the counties to conduct more than 20 focus groups of 10-12 people each who were part of the initial surveys, with more planned. Some focus groups scheduled for the spring of 2020 in Chase County were postponed because of the COVID-19 pandemic. She said the focus groups that were held were able to identify specific needs in each county ― and that the surveys and focus groups have already led to some changes.

“In Haskell County, where residents said a childcare center near the county’s Santana District Hospital would be a great recruiting advantage for attracting health care workers, a new center has opened near the hospital,” Johnston said.

Johnston said while the pandemic has had an impact on some of the survey work, she’s optimistic that the project will be back on track in 2021.

“We obviously have had to rethink our strategy moving forward due to the pandemic,” Johnston said. “Our team at KU has been retooling our surveys so they are available in both paper and electronic form. We are hoping the pandemic will be under control by fall 2021 so that we can conduct face-to-face focus groups, but we also are planning on using Zoom technology as an option just in case.”

Johnston said the 2020 Blue Cross Blue Shield’s Pathways to a Healthy Kansas program was offering Kansas counties the community assessment project as one of their grant options. Three counties have already reached out to Johnston and are making plans to implement the survey and focus groups in 2021.

She added that her old friend Benjamin Anderson has left Kearny County Hospital and is now vice president of rural health and hospitals for the Colorado Hospital Association. He has been talking with Johnston about providing coaching for partners in four rural/ frontier counties in southeast Colorado that are interested in implementing a similar health and wellness survey.

“Our goal with this project is to help communities in Kansas and beyond to mobilize around health and wellness,” Johnston said. “We truly believe it can make a difference in the well-being of our rural residents.”

The KU School of Medicine-Wichita contributed to this story.