The expertise and guidance of Judy Johnston, a research instructor at KU School of Medicine-Wichita, are helping a hospital and county in far western Kansas better understand the health needs of their diverse communities. 

"Community participatory research is what I really love," said Johnston, who joined the Department of Preventive Medicine and Public Health in 2003. "I get to do the things I care about, and I just love the kind of work we're doing in Kearny County."  

That work has involved consulting with Benjamin Anderson, the CEO of Kearny County Hospital in Lakin, who built a medical team by attracting physicians interested not only in serving the rural county west of Garden City but also vulnerable populations around the world. Johnston created a survey that, through the efforts of summer interns and dozens of community volunteers she trained, reached four out of five of the county's households - 865 total - a rate rare in the statistical world.  

"Benjamin asked how many households we wanted, and we said, 'If we could get 80 percent ...," Johnston said. "And we laughed about it, because nobody gets 80 percent. In usual Benjamin fashion, he said, 'Well, we're going to get 80 percent.'"  

Initially, Anderson and the hospital wanted to better understand what led some 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 influence health - child care, education and faith communities are just a few examples.  

"Hospitals and all kinds of systems tend to ask people how are we doing, not how are you doing," 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 much bigger than health care."  

The survey revealed a need for better child care, greater access to primary care, a desire for walking paths and other exercise possibilities, and a shortage of healthy food options, among other findings.  

"Judy gets rural Kansas. She's an engaging personality, extremely organized and understands the dynamics in rural Kansas," Anderson said. To the student interns and the survey collectors, "she gave a very organized, structured system that they didn't have to invent. She was just a great match."    

What the survey entailed

The three-part 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? Was it a lifelong process of people learning and making choices?  

A second section drilled down and asked residents about resources the community had or needed in eight areas: health care, public health, early child care and preschool, schools, faith communities, work sites, K-State Research & Extension at the county level, and the community at large. Finally, it gathered household demographic information including race, ethnicity, age, employment, education and health insurance status. Participants had anonymity, but addresses were collected to ensure areas weren't missed.  

Two successive pairs of interns from Baylor University and its medical school - a connection Anderson formed via his mentor, who leads the Baylor Scott & White Health system - managed the survey and worked with 45 community volunteers who did the collecting. Anderson said that one intern decided to include KU on his medical school application list because of the experience he'd had in Lakin.  

"They went to the fair, they went to school registration and Deerfield Days, the senior center, anyplace people were gathering," said Johnston, whose role was funded by a KDHE grant. Another grant delivered resources to encourage participation. "We were providing Subway gift cards to people filling out the surveys, but we were also providing incentives for people who collected the most surveys."  

Using maps, the interns tracked completed surveys, and in one community found a big hole. Deerfield and Lakin are the county's two big towns, with Deerfield being closest to Garden City and the Tyson beef plant in Holcomb. The students discovered that many residents they were missing worked for Tyson, so they approached the company.  

"They convinced Tyson to select 101 people who live in Kearny County to fill the survey out.  It was a big deal," Anderson said. "They collected the majority of those people, simply because they could pull them off the line and do it on the clock."    

What the survey found and triggered

Since surveys were completed over the summer, the data has been compiled and analyzed. Johnston has conducted more than 20 focus groups along the survey's eight sectors, with more planned. The research will be shared via a poster at the Society of Behavioral Medicine annual meeting in March in San Diego, and a full report should go to the community this spring.  

The findings paralleled a hospital effort to add physicians and other providers and boost its ability to provide primary care. The hospital now has six family medicine doctors - all but one graduates of KU School of Medicine or the KU-sponsored residency program at Via Christi - and has added hundreds of new patients at its clinics, Anderson said. That has helped keep non-critical patients out of its ER.  

Child care was another common concern in the surveys and focus groups that followed. "What that did was bring to our attention how few child care resources there are in the county. They just aren't there," Johnston said.  

Now, the hospital is working with Johnston and others to study the creation of a child care center, using space at the senior center adjacent to the hospital. Additional interns will work on that initiative next summer, while others will replicate the survey in Haskell County and one or two other communities.  

Other concerns raised by the survey include that Kearny County, despite being an agricultural producer, is a "food desert." Another common issue was a lack of healthy exercise options, especially walking paths. The community received a sizable Blue Cross Blue Shield Pathways to Healthy Communities grant this past summer, and resources from that can go toward those and other issues.  

"The takeaway is that Kearny County is a tough place to stay healthy, but it doesn't have to stay that way," Anderson said, noting that many residents are engaged in tackling such problems. The hospital and county have reached well beyond western Kansas to find grants, expertise, and solutions, and KU's Johnston has been a key part of the mix.  

"Judy is a gateway to resources," Anderson said. "She shares our social conscience and our commitment to people who are vulnerable. When you have people motivated by the same thing and are competent, things will happen."