A Partnership for Health and Safety of Farm and Ranch Families

Bringing a group of diverse agencies together to address a common concern can challenge even the best of Extension workers. While partnerships are not always easily formed, successful partnerships can provide greater results and benefits to clientele than might otherwise be obtained.

Goal 3 of the Cooperative State Research, Education and Extension Service (CSREES) Strategic Plan is "A Healthy, Well-Nourished Population" (United States Department of Agriculture, 1997). The second objective of this goal is "to promote health, safety, and access to quality health care." Extension workers are encouraged to work with partners and cooperators to improve individual and family health status through non-formal health education and promotion programs, and to improve safety levels that could result from accidents in the home and worksites.

Community partnerships can work to address health issues by either creating an awareness of needs or creating an environment that facilitates changes (Butterfoss, Goodman, & Wandersman, 1993; Harris, Richter, Paine-Andrews, Lewis, Johnston, James, Henke, & Fawcett, 1997). When diverse groups come together to achieve a common purpose, the outcome is often more efficient and effective for the targeted audience (Hastad & Tymeson, 1997). This is especially important as we try to reach both underserved and high-risk populations in better ways (Poole & Hook, 1997). In the future, there is likely to be increasing pressure to forge new partnerships between public and private sectors to achieve these goals (KPMG Peat Marwick, 1997).

Collaborative partnerships must be mutually beneficial. Such partnerships can result in cost-savings, mutual community service, better opportunities for obtaining external funds, and educational support (Hastad & Tymeson, 1997). When colleges and universities are involved, partnership activity may become a practical training ground for students as well as an opportunity to return benefit to the community that supports them (Deutsch, 1997).

Partnerships begin with the identification of a perceived community need (Bazzoli, Stein, Alexander, Conrad, Sofaer, & Shortell, 1997; Hastad & Tymeson, 1997). Next steps include identification of those in the community who have the willingness and ability to serve in a partner relationship. Partners will take on shared responsibilities and risks as well as rewards.

In that context, this article describes the development, activities, and outcomes of a rural community health partnership. The partnership was formed to promote health and safety among a potentially underserved rural population and to encourage clientele access to existing health services.

Rural Partnership Development

The Nebraska panhandle is a large rural area (15,000 square miles) with a population density of approximately 6.25 persons per square mile. Of the 11 panhandle counties, 6 are federally designated primary care health professional shortage areas (HPSA). Three counties are federally designated medically underserved areas, and 2 other counties have populations medically underserved (Office of Rural Health, Nebraska Health & Human Services System, personal communication, August 1997).

In 1995, representatives for health service agencies and educational institutions met to discuss the health and safety needs of ranch and farm families within the region. Institutions or agencies that were represented included a regional medical center, medical foundation, university Extension service, university learning center (distance education), and the western division of a university medical center nursing college.

Early in the planning process the partners identified the four leading causes of unintentional work-related deaths for U.S. farmers to be agricultural machinery, motor vehicles, falling objects, and electricity. Agricultural machinery is also a leading cause of non-fatal injuries among farmers. Livestock-related accidents and respiratory disorders among hog and cattle confinement operators also are concerns for this population. Heart disease and cancer were identified as leading causes of death for adults in rural Nebraska, as they are in the rest of the United States population (Nebraska Department of Health, 1996).

These morbidity and mortality figures for farmers and ranchers indicated a need for a programming effort to address prevention steps. It was decided that a special event that would include a combination of health screening, educational seminars, and opportunities for immunizations would be useful.

Rural Health Partnership Activities

A 1-day educational event preceded by prearranged opportunities for health screening was organized. Opportunities for health screening were deemed essential in assisting families into the health care system. The educational seminars included topics such as:

• prevention of work-related accidents,
• working with livestock,
• tractor/power safety,
• safe use of pesticides,
• ways to prevent respiratory disorders,
• diet and heart disease,
• cancer risk reduction, and
• improving family communication.

Written screening panels provided an analysis of diet, stress, exercise, cardiac, and cancer risk factors. Physical screening for blood pressure, blood cholesterol levels, and colorectal cancer was also completed. A PAP smear and/or mammogram were available to eligible women as part of the screening package. Additional screening tests offered but not required included hearing, blood glucose, and pulmonary function tests.

The screening and assessments were scheduled to be completed prior to the conference so that results could be shared with each conference participant by registered nurses on the day of the conference. Guidance and referral were provided when necessary or indicated. To remove one of the barriers in access to quality health care, payment for the screening and tests came from subsidies from the medical foundation, when necessary.

To further meet the needs of entire farm and ranch families, an educational program for children was included. Children aged 5-to-11 attended sessions on avoiding common accidents, playing safely, and how to do a "Safety Walkabout." They attended sessions or exhibits on electrical accidents and vehicle/train accidents.

For these events the planning partners assumed various responsibilities. Cooperative Extension provided contacts with potential clientele and some of the educational programs. Personnel at the partner medical center managed screening schedules. The university learning center handled registration and marketing. Faculty and students of the college of nursing provided screening assistance, gave immunizations, and managed the children's program. Numerous volunteer nurses presented the screening results to all participants. Other speakers for the educational sessions came from the health community within the region and state.

Although the first planned educational and screening event was met with enthusiasm, some problems emerged. Schedules for some of the pre-arranged screening exams were overloaded and caused confusion among the participants. At the day-long educational activity, insufficient time was allotted with the professional nurses for the personal summary and referral of screening and assessment results. In some cases, both men and women expressed high levels of stress and confided they felt the need for help but didn't have the time, money, or confidence to seek counseling. These issues were discussed by the planning partners and helped to establish some of the changes for continuing efforts to reach this audience.

A second educational and screening event was planned for farm/ranch families. Collaborating partners were added to the planning group, including other hospitals that could serve as additional screening sites. Educational sessions for adults included farm/ranch stress, emergency first aid, arthritis/back pain, nutrition, respiratory disorders, and cancer risk reduction. A children's program was again included.

A dermatologist to conduct full body screening for skin cancer was added to the screening and assessment package. More time for summary and referral was allotted for each participant by recruiting more volunteer nurses.

Programming Outcomes

Approximately 1 year after the first two health and safety education and screening events, participants were surveyed regarding their health practices. Questions from the original health screening assessment tool were included in the survey so they could be compared to original responses. These questions centered on medical history and health habits related to food, exercise, smoking, and recommended medical screening. One hundred eighty persons were contacted, and 82 surveys were returned (46% response rate).

These planned events were found to be most helpful in improving the breast and cervical cancer screening practices of the female participants. At initial assessment, 57% of the women reported having a mammogram within the previous year, compared to 91% at the final assessment. Similarly, 60% of the women at the initial assessment reported having a clinical breast exam within the previous year, compared to 79% at the final assessment. There were also trends toward improved cervical cancer screening (62% versus 77%).

Through the continuing years of the partnership, one woman discovered a malignant breast tumor at a very early stage and sought treatment; several farmers had suspicious skin lesions removed; more than 75 people were immunized against flu, pneumonia and tetanus; and nearly 300 farmers/ranchers and their spouses have participated in educational sessions to learn ways to maintain their health and prevent disability.

The rural health partnership was formed to address a key objective of improved health and safety for this targeted audience. The planned events emphasized the importance of having regular and recommended health screening, and they were successful in assisting persons in scheduling them. Whether individuals will schedule their own screening without the reminder and support from the event organizers is yet to be determined.

Continuing Partnership

The rural health partnership has continued working together to reach the intended audience. More health professionals have volunteered to assist with immunizations, registration, on-site screening, and results and referral. Medical facilities from six communities participate in screening activities prior to educational events, which is helping to improve the access to health care for this rural population. Nursing students have been able to apply public health and community health principles as they planned the children's program, administered immunizations, and answered questions about health. Cooperative Extension has been able to expand its health and safety education outreach.

This partnership for health for farm and ranch families was established out of a common desire to develop a healthier community among those who live and work in rural Nebraska. The planning and implementation processes taught the partnership members more efficient ways to screen this sparsely dispersed and underserved population while providing educational sessions. A model has been established that could be applied in similar rural areas.

References

Bazzoli, G.J., Stein, R., Alexander, J.A., Conrad, D.A., Sofaer, S., & Shortell, S.M. (1997). Public-private collaboration in health and human service delivery: Evidence from community partnerships. The Milbank Quarterly, 75(4), 533-563.

Butterfoss, F.D., Goodman, R.M., & Wandersman, A. (1993). Community coalitions for prevention and health promotion. Health Education Research, 8, 315-319.

Deutsch, C. (1997, May-June). Mutual benefit, mutual respect. World Health, 50(3), 14-16.

Harris, K.J., Richter, K.P., Paine-Andrews, A., Lewis, R.K., Johnston, J. A., James, V., Henke, L., & Fawcett, S.B. (1997). Community partnerships: Review of selected models and evaluations of two case studies. Journal of Nutrition Education, 29(4), 189-195.

Hastad, D.N., & Tymeson, G. (1997). Demonstrating visionary leadership through community partnerships. Journal of Physical Education, Recreation & Dance, 68(5), 47-51.

KPMG Peat Marwick LLP. (1997). Organizations serving the public: Transformation to the 21st century. New York.

Nebraska Department of Health, Data Collection Section. (1996). 1996 Vital Statistics Report. Lincoln, NE.

Poole, D.L. & Hook, M.V. (1997, February). Retooling for community health partnerships in primary care and prevention [Editorial]. Health and Social Work 22(1), 2-4. Available: http://www.reeusda.gov/part/gpra/stratpl.htm

United States Department of Agriculture. (1997). Cooperative State Research, Education, and Extension Service Strategic Plan [On-line].