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A summary of presentations from the weekly Summit partner webinars

September 16, 2021 – The latest Summit summary

EXCITE (Extension Collaboration Immunization Teaching and Engagement) – Michelle Rodgers (University of Delaware)

Michelle Rodgers, EXCITE (Extension Collaboration Immunization Teaching and Engagement) project director, associate dean and extension director, University of Delaware gave a presentation on the EXCITE program.

EXCITE is an initiative of the Cooperative Extension System to address health disparities among rural and underserved communities. This initiative is funded by the Extension Foundation, in cooperation with the Extension Committee on Organization and Policy, through an Interagency Agreement with the USDA National Institute of Food and Agriculture and the CDC.

What is Cooperative Extension?

Cooperative Extension, funded by federal, state, and local partnerships, is a part of the Land-Grant University system. The land-grand universities were established at the time of the Civil War with the goal to bring university education to the common person. There are currently 111 land-grant institutions across the country, with at least one in every state. Fifty years later, the cooperative extension system was formed to bring the research of the land-grant institutions to the common person and address community needs with roots in agriculture, family, and the youth 4-H program. There is a local faculty or staff member from each institution with expertise in education and subject matter who works in each local community.

EXCITE projects

CDC has partnered with Cooperative Extension, as Cooperative Extension is a trusted source of education in the community. This is a $9.9 million two-project partnership that spans across the country in every state. The projects include:

  1. Vaccinate with Confidence is the first project available to all land-grant universities. The project includes educating the communities of greatest need focusing on those areas unmet by other organizations in the state. The project is non-competitive, began this spring, and will last for one year.
  2. Impact Collaborative pilot projects are selective, competitive projects focused on adult immunization education for both COVID-19 and all other adult recommended vaccines. This is a two-year project.

Vaccinate with Confidence

The objectives for the Vaccinate with Confidence project include:

  • Decrease vaccine hesitancy among rural and medically underserved audiences
  • Increase connection and communication between priority populations and healthcare systems
  • Increase accessibility of vaccination clinics to priority populations

Seventy-two universities have stepped up for this one-year project. These universities along with the CDC have determined where there the greatest need is and what opportunity there is to connect and have contact with different audiences than the state immunization organizations have been working with. Audiences most often include:

  • Agriculture workers
  • Faith based communities
  • Low resource individuals, families, or communities
  • Tribal communities
  • Rural communities
  • Communities of color

Pilot Projects

There are 24 pilot projects with competitive funding over two years that involves 32 institutions. Local rapid community assessments about the specific needs of the audiences and market-testing help evaluate how to provide education and how to tailor a message that will reach selective audiences. Audiences include:

  • Meat Packers
  • Immigrant and Migrant farm workers
  • Limited resource communities
  • African American Communities
  • Latino Communities
  • Youth Leaders 4-H program – One Health (working with other volunteer adults)

Partnership

The program team includes members from CDC and faculty and staff from across the country who have come together to form the project team. The Ad Council has focused on educating the rural population and have shared resources that aid in communicating with a rural audience. Within the land-grant institutions, staff have been taught to be informed about their own hesitancy. Health sciences colleges, medical centers, and medical colleges are also being included to help aid in education and share messaging. Many other partners are working with the community as well. New partners are always welcome to help educate, inform, and make a difference.

What’s going on in your state?

You can learn about the extension projects happening in your state/location by clicking on this MAP. Enlarge the map and click on the location where you’d like to find out more information. Below the map there is a contact for every extension system across the country. These are teams that you can partner with if you are interested in linking up with the project being done. On left side you can click on the various programs being offered for each state. When you click on it, it will give more info on what is being developed. This is updated monthly.

Data from the first quarter

There are multiple ways that EXCITE is trying to reach their audiences. After three months, they are finding that the most productive ways are through social media, radio, print media, and television ads. EXCITE is compiling all of the resources that have been developed and tested across the Cooperative Extension programs. All of the materials can be used and found online at www.pages.extension.org/excite.

There have been some very successful projects so far. The University of Vermont is using Whatsapp technology to connect with the migrant labor audience. They have also been bringing immunization clinics directly to the farm and working with the farm operator to bring vaccines directly to the laborers. At Lincoln University in Missouri, they are working with individuals in the Black community to educate about vaccinations.

Additional New Efforts

There will be more training with staff about vaccine hesitancy, as well as creation of more resources. There is also a new project beginning that is specifically focused on tribal colleges. There will be further investments with pilot projects.

For questions, email Michelle Rodgers at mridgers@udel.edu.

Questions

Question

Do you have a way to reach out to the local faculty or staff member from a specific institution?

Michelle Rodgers

All contacts can be found on the Impact Map web page.  This page can get you to local communities and the member to contact in that location.

Question

Are you all at EXCITE engaging the immunization coalitions that are in the states, as well?

Michelle Rodgers

Yes. We are doing this in conjunction with the coalitions in each state so that we can figure out where the greatest need is. Everyone needs to come together in partnership to get this work accomplished.

Question

Do you connect with the local health departments?

Michelle Rodgers

Yes. Cooperative Extensive has worked in the area of health across time. We are most known for work in nutrition, but we have really changed as an organization and are now working more broadly in the area of health. We have a national health director now and we hire people that have degrees in public health, particularly in community education. Many state health departments are starting to make local connections, but this is not the same in every state. Each state is funded differently, so the states don’t all work the same.

Question

Are there upcoming opportunities to join the collaborative? 

Michelle Rodgers

You are welcome to connect with me (mridgers@udel.edu) or with your local community representative. I welcome follow-up and wouldn’t love to talk about opportunities where we might collaborate in connections with states where we could do that. We would love to make connections we haven’t yet made at the local, state, or national level.

Question

Does the project work with schools, as well?

Michelle Rodgers

The funding from CDC focuses on adult immunization. We are working particularly with COVID-19 and coming into the fall, influenza vaccinations. Other adult immunization education will be a part of the second project. We do work with the youth 4-H program; however, the focus for these two projects is largely on adults or on questions adults have about getting their children vaccinated.

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CDC Rural Public Health Update – Diane M. Hall (CDC)

Diane M. Hall, PhD, MSEd, senior scientist for Policy and Strategy and CDC’s Rural Health Lead, Centers for Disease Control and Prevention, gave a presentation on CDC rural health update. 

Rural: What is it and why focus on it?

The term “rural” is different everywhere and the variations are becoming increasingly diverse in terms of ethnicity. A paper that looked at economic factors as well as population inflow and outflow and they determined there were three types of “rural” in the U.S.:

  • Wealthy areas that have some sort of natural resource like mountains or a beach. These places also have a hospital.
  • Communities in transition that fall in between. These places also often have natural resources available.
  • Persistently poor areas

There are over 70 definitions of the word “rural” used by the federal government, and they are all pretty much a variation on a handful of these definitions. In 2013, the CDC established NCHS Urban-Rural Classification Scheme for Counties. Most of the counties in the U.S. are not metro, but functionally rural. One thing these definitions have in common is that “rural” is always “what’s left over.” So, the language often used is “rural” or “non-rural.”

What are some rural challenges?

The CDC began documenting these challenges in 2017 in their 13-report series, with the first report in January of 2017 focused on the leading causes of death. This got a lot of attention because people were not familiar with rural communities, and this shined a light on the challenges the communities face. The National Center for Health Statistics (NCHS) now publishes 5-6 rural health reports every year.

What are the causes of deaths by rurality and the trends over time?

 A study looked at the five leading causes of death––cancer, heart disease, unintentional injury, chronic lower respiratory disease, and stroke––in six classifications rural and non-rural communities. The most rural areas had the highest rates of deaths.

Health disparities can be found in rural communities.

A study looked at health behaviors and found that rural communities had higher rates of cigarette smoking, hypertension, obesity, and physical inactivity during leisure time. They also found that there tend to be more rural residents living in poverty and residents are more likely to report less access to health care and lower quality of healthcare.

There are barriers to accessing health services in rural areas.

Distances, transportation, health insurance coverage, health literacy, stigma, privacy, workforce shortages, and limited capacity are all barriers to accessing health care in rural areas. Poverty is also another barrier to accessing health care services in rural communities.

CDC’s COVID-19 Data Tracker and Rural Demographic Trends tab

CDC’s COVID-19 Data Tracker has the NCHS metro/non-metro classification added to the demographics tab. With the data tracker you can add all six categories of metro/urban/rural to see which communities have the most deaths. In the graph for cumulative deaths you can see that early in the pandemic, COVID-19 was mostly a metro/urban problem, but eventually it came into rural communities and now the rate of death from COVID-19 is higher in rural areas.

Also added from NCHS on the data tracker are vaccine confidence and equity information.

Assets and Opportunities

When looking at the market research, it seems as though creativity in educating plays a big role in reaching rural communities. Often in these communities vetting and approval of communication and educational materials moves through the approval process faster, as there are often less people who need to sign off on the projects and materials. Also found through market research are the values people in rural communities often find most important:  kinship, independence, “the communal individual,” pride of place, trust in neighbors, “native wisdom,” and a hard-working mentality.

The Importance of Rural Culture and History

In 2018 the National Opinion Research Center (NORC) at the University of Chicago focused on the things that are going well in rural communities. Their findings included:

  • Social connectedness, cooperation, cohesion
  • Importance of family and neighbors
  • Religious affiliation
  • Pride in self and family
  • Self-reliance and independence
  • Importance of justice, loyalty, and faith
  • Regional differences

The priority of being resourceful, autonomous, and independent is a double-edge sword that can sometimes lead to communities having skepticism toward outsiders, being reluctant to try something new, and not trusting the government.

State-level connections

State Office of Rural Health (SORH) – every state in the U.S. has an office of rural health. They vary widely in terms of their capacity and efficiency and are specifically funded to serve as the communication conduit between the state and rural community.

State Rural Health Associations  – There are 44 states covered by a state rural health association.

County and city connections

National Association of County and City Health Officials (NACCHO) published a directory with COVID-19 points of contact.

National Association of Counties’ (NACo) COVID -19 resource web pages:

Rural Health Clinic (RHC) Program

HRSA in collaboration with CDC is funding a Rural Health Clinic Program so that rural health clinics can do COVID-19 testing, mitigation, vaccine confidence education, and provide vaccinations.

Funding to states

Public Health Departments have received awards ranging $500,000 to $50 million, with a period of performance 2 years to address COVID-19-related health disparities, advance health equity including among racial and ethnic minority groups and people living in rural areas.  There were 107 awardees, including awardees with rural carve-out for each state.  www.cdc.gov/publichealthgateway/partnerships/COVID-19-Health-Disparities-OT21-2103.html.

In addition, Immunization Programs were awarded $3 billion for 64 jurisdictions to ensure greater equity and access to COVID-19 vaccine.  www.cdc.gov/vaccines/covid-19/downloads/COVID-19-Vaccination-Supplemental-4-Guidance.pdf.

Further, the Chronic Disease Center at CDC funds 26 Prevention Research Centers that focus on chronic illness to focus also on vaccine confidence education.

CDC’s Rural COVID-19 Resources

CDC Resources (Not Rural-focused)

CDC Resources for Providers

Non-CDC resources – Communication Resources and Toolkits (Rural-focused)

Takeaway message

Thinking about “rural” in terms of geography leads you to think about distance, but if you think about the culture and history in terms of ideology, that will help you think about different ways to work with rural communities.

Questions

Question

How does the lack of broadband internet access in rural areas affect community health? 

Diane M. Hall

This is a big factor. People have trouble accessing healthcare services, as well as training and educational materials.

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National Minority Quality Forum Vaccine Equity Update – Laura Lee Hall (Center for Sustainable Health Care Quality and Equity, National Minority Quality Forum)

Laura Lee Hall, PhD, president Center for Sustainable Health Care Quality and Equity, National Minority Quality Forum, gave a presentation on National Minority Quality Forum Vaccine Equity update.

Why do we care about equity in vaccination?

COVID-19 is more deadly and prevalent in people of color. These communities tend to have lower vaccination rates, including flu vaccination rates, which has been consistent over time. The result of reduced vaccination rates is higher rates of illness and death. Therefore, vaccination is a matter of life and death.

The National Minority Quality Forum

The National Minority Quality Forum, which includes Sustainable Health Care (SHC), was started by Gary A. Puckrein, PhD (founding president and CEO) 20+ years ago. This was formed to address the critical need for strengthening national and local efforts to use evidence-based, data-driven initiatives to guide programs to eliminate the disproportionate burden of premature death and preventable illness for racial and ethnic minorities and other populations.

The vision is to have sustainable healthy communities in every zip code. And the mission is to promote sustainable healthy communities, especially those with diverse and underserved populations, through the provision of actionable data, research, and engagement/training of clinicians and community leaders.

There are opportunities for individuals, healthcare systems, FQHCs, practices, and community leaders.

Resources offered by the National Minority Quality Forum

  • Get the Vax Facts (#dontwaitvaccinate) campaign, which includes media training, communications toolkits, public relations, and events.
  • Champion Co-Lab is a learning community that is moving to implement programming in their regions. Champions in the Co-Lab engage in monthly activities to promote equity in vaccines (currently for COVID-19 and flu vaccines), peer-to-peer learning labs, and communications. Join the Champion Co-Lab.
  • DRIVE Toolkit is a free online toolkit with templates, how-to’s, and educational materials that practices can use to implement a quality improvement program around influenza and COVID-19 vaccines. The toolkit was guided in its development by many people and built around a model that starts with evidence-based approaches to increasing vaccines. Full 2020 DRIVE advisory group meeting summary and results.

A few projects

Daily Planet Health Services (DPHS)

Partnered with the DPHS in Richmond, VA and were able to increase flu vaccination by two-thirds through:

  • Identification of Flu Vaccine champions at each site who received additional training via an in-service with lunch provided by DPHS. The same strategies to assist in vaccinating Richmond’s homeless population.
  • An alert and quick order set was created in their electronic medical record.
  • Flu vaccination awareness flyers and posters, in both English and Spanish, were placed in their lobby areas and exam rooms at each facility. Attire buttons were given to all employees to further raise awareness.
  • DPHS worked with community partners to provide onsite medical outreach to include flu vaccines.

Protecting Our Communities from Influenza and COVID-19 through Knowledge and Vaccination – Baltimore-Prince Georges County, MD

This project included working with six clergy leaders in Baltimore, MD to help them increase vaccination engagement with their congregations, as well as the local media, to team up with the health department, and put shots in arms. They had vaccination sites at senior living facilities and a church parking. Through this, they saw a 13% increase in flu vaccinations over the prior year.

Coming soon

  • Expanded working with the Barber and Stylist Network around the country
  • Building on the faith health alliance in ten cities with Black clergy leaders
  • Developing a program in northern Virginia to train pharmacist community ambassadors to get out in front of the public so they can use their knowledge and be seen as a trusted health resource in places where provider access is limited

These efforts and resources were supported by the CDC, Sanofi Pasteur, the SHC team, and many other collaborators and partners.

For follow-up, please contact shc@nmqf.org.

Questions

Question

How do you partner with states and local health departments, and do you have state-specific contacts?

Laura Lee Hall

We look forward to partnering with health departments and connecting them with people we are training––providers, health systems, clergy leaders, and other community leaders. This is an important partnership.

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ANNOUNCEMENTS

L.J Tan (IAC)

The Immunization Action Coalition (IAC), with funding support from Seqirus, is offering a limited quantity of FREE Flu Vaccine buttons and stickers in English and Spanish to support your flu vaccine promotion efforts this season. To receive these supplies at no cost, please PRE-ORDER your buttons and stickers now. Delivery (also at no cost) is anticipated by early October. Order the flu buttons and stickers.

 

IAC hosted two influenza webinars this September that can now be viewed online.

 

We would like to welcome having more NAIIS member organizations to add their support to the Call to Action on adult immunization. Access the call to action and click on the top righthand button to add your organization.

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