Center for Rural Community Health (BCRCH)
Bassett’s Center for Rural Community Health addresses complex health issues challenging the small rural communities of Bassett’s eight county region. This region includes some of Appalachia’s northern-most counties. These and their neighboring counties contain many rural communities afflicted with similar demographic, economic, and infrastructure challenges and having disproportionate numbers of citizens who are aged, impoverished, isolated, obese, and otherwise challenged.
The BCRCH conducts rural risk research, works with community partners to implement policies and programs, provides technical assistance, and participates in advocacy for and dissemination of best practices.
The Longitudinal Research on Aging Drivers (LongROAD) Study
The Longitudinal Research on Aging Drivers (LongROAD) Study is a multi-site cohort study of factors that predict the ability of older adults to continue driving safely (and factors that preserve quality of life when older adults reduce or discontinue driving).
The LongROAD Study is funded by the American Automobile Association Foundation for Traffic Safety and supports the enrollment of approximately 3000 65-79 year old adult drivers in five sites (Cooperstown; Baltimore MD; Denver CO; Ann Arbor MI; San Diego CA). The study’s lead institution is the Mailman School of Public Health of Columbia University, and other participating institutions besides the Bassett Research Institute are the Johns Hopkins University, the University of Colorado, the University of Michigan, and the University of California at San Diego. Information being collected on the study participants includes detailed measurements of physical and cognitive functioning; health conditions and medications; the condition and safety features of participants’ vehicles; and driving-related behaviors. Data are collected from in-person interviews and examinations; medical and motor vehicle department records; and GPS measurements of driving patterns. In the first phase of the LongROAD Study the driving experience of these adults will be followed for their first five years in the study.
A sample of peer-reviewed publications about the LongROAD Study includes the following:
Li G, Eby DW, Santos R, Mielenz TJ, Molnar LJ, Strogatz D, Betz M, DiGuiseppi C, Ryan LH, Jones V, Pitts SI, Hill LL, DiMaggio CJ, LeBlanc D, Andrews HF for the LongROAD Research Team. The Longitudinal Research on Aging Drivers (LongROAD) Study: Study Design and Methods. Injury Epidemiology 2017; 4(1):22. doi: 10.1186/s40621-017-0121-z. Epub 2017 Aug 1. PMID: 28736796
Molnar LJ, Eby DW, Vivoda JM, Bogard SE, Zakrajsek J, St.Louis RM, Zanier N, Ryan LD, LeBlanc D, Smith J, Yung R, Nyquist L, DiGuiseppi C, Li G, Mielenz TJ, Strogatz D and the LongROAD Research Team. The Effects of Demographics, Functioning and Perceptions on the Relationship between Self-reported and Objective Measures of Driving Exposure and Patterns among Older Adults. Transportation Research Part F: Psychology and Behavior 2018; 54:367-377.
Ng LS, Guralnik J, Man C, DiGuiseppi C, Strogatz D, Eby DW, Ryan LH, Molnar LJ, Betz ME, Hill L, Li G, Crowe CL, Mielenz T. Association of Physical Function with Driving Space and Crashes among Older Adults. The Gerontologist 2019; Jan 8. doi: 10.1093/geront/gny178. PMID: 30624694
Strogatz D, Mielenz T, Johnson A, Baker I, Robinson M, Mebust S, Andrews H, Betz M, Eby D, Johnson R, Jones V, Leu CS, Molnar L, Rebok G, Li G. Importance of Driving and Potential Impact of Driving Cessation for Rural and Urban Older Adults. Journal of Rural Health 2020; 36:88-93.
Rural Health Education
A major component of the rural community effort is the Research Institute’s Rural Health Education Network of Schoharie, Otsego, Montgomery Counties (RHENSOM), funded by the New York State Office of Rural Health.
RHENSOM is dedicated to serving the health needs of our communities through innovative, evidence-based programming and initiatives. RHENSOM was successful in securing a new five year contract from NYS DOH, which began in January 2019.
Key areas of work in 2019 focused on two overarching objectives. The first was to address health disparities associated with chronic disease. We partner with the Living Well program, Cornell Cooperative Extension and other community partners to offer classes and events throughout the year to support individuals’ efforts to improve their health. RHENSOM’s second goal is to empower both seasoned healthcare professionals and youth to become more engaged in creating a healthy environment. This is accomplished through offering a variety of professional development opportunities for nurses and providers, as well as sponsoring events for school-aged children such as the Cardiac UpClose program and Jr. Iron Chef.
In 2016, Bassett Medical Center received a three-year Small Health Care Provider Quality Improvement (QI) grant funded by the US Health and Human Services Administration to utilize the evidence-based Diabetes Self-Management Program (DSMP) and Chronic Disease Self-Management Program (CDSMP) developed at Stanford University as a framework for QI in eight clinic sites.
Unique to BMC's "Living Well" self-management program, is session seven, wherein DSMP participants meet with a diabetic nurse educator and CDSMP participants meet with a nutritionist. Participants also have the opportunity to enroll in the self-directed, evidence-based Walk with Ease program developed by the National Arthritis Foundation.
Bassett Research Institute staff oversee implementation and evaluation of the Living Well program. A strong evaluation plan and community connectedness led to another successful application. In 2018, the Research Institute received an additional three years of funding from the Health Resources and Services Administration (HRSA), Rural Health Care Services Outreach Grant Program. Research staff are charged with leading a consortium of six health care providers and human service agencies to deliver the evidence based Chronic Pain Self-Management Program (CPSMP) to residents living in Chenango, Herkimer, Madison, and Otsego counties. Additional small regional grant awards have allowed for expansion to Schoharie and Delaware Counties.
Living Well with Chronic Obstructive Pulmonary Disease (COPD) and Asthma
BCRCH is collaborating on the development and evaluation of a community education program for adults with COPD or asthma. The program includes one-on-one sessions with a respiratory therapist, along with group education on COPD and asthma, followed by the 6-week Chronic Disease Self-Management Program (see Living Well above).
Cardiovascular Disease in Rural Women
Strong Hearts, Healthy Communities (SHHC) is a NIH-funded project directed by Rebecca Seguin, PhD, at Cornell University’s College of Human Ecology. The SHHC project targets at-risk women in medically underserved areas for cardiovascular disease prevention efforts. This community-based program developed specifically to be feasible in isolated rural communities with limited resources, uses education, strength training, aerobic exercise, and dietary intervention, as well as behavioral and civic engagement strategies to address risk in sedentary middle-age and older overweight rural women.
In the initial phase of SHHC, the Research Institute oversaw this intervention in two central NY sites and collected similar data at two control sites. The data from New York were combined with a larger number of sites in rural Montana. Outcome measures included changes in CVD-related anthropometric, physiologic, behavioral, and psychosocial parameters. Behavior and attitude change within each of the participants’ social networks were also measured.
Analyses and feedback on the first phase of SHHC led to refinement of the intervention strategies and a second community-randomized trial of its impact – the second phase was conducted exclusively in 11 rural towns and villages of central upstate New York.
The major results of SHHC on risk factors for cardiovascular disease in the women who received the intervention are summarized in these publications:
Seguin RA, Paul L, Folta S, Nelson M, Graham M, Diffenderfer A, Eldridge G, Strogatz D, Kenkel, D. Strong Hearts, Healthy Communities: A Randomized, Multilevel Cardiovascular Disease Risk Reduction Lifestyle Intervention Trial. Obesity 2018; 26:845-853. doi: 10.1002/oby.22158. Epub 2018 Apr 10. PMID: 29634086.
Pullyblank K, Strogatz D, Folta SC, Paul L, Nelson ME, Graham M, Eldridge G, Parry SA, Mebust S, Seguin RA. Effects of the Strong Hearts, Healthy Communities Intervention on Functional Fitness of Rural Women. Journal of Rural Health 2020; 36:104-110.
Seguin-Fowler RA, Strogatz D, Graham ML, Eldridge GD, Marshall GA, Folta SC, Pullyblank K, Nelson ME, Paul L. The Strong Hearts, Healthy Communities Program 2.0: A Randomized, Controlled Trial Examining Effects on Simple 7. American Journal of Preventive Medicine 2020; in press.
Creating Healthy Schools and Communities
Creating Healthy Schools and Communities (CHSC) is a five-year (2015-2020) public health initiative to reduce major risk factors of obesity, diabetes, and other chronic diseases in these 5 high-need school districts and associated communities – Charlotte Valley, Walton, Sidney, Unatego and Richfield Springs.
The New York State Department of Health (NYSDOH) awarded the grant to the Research Foundation for SUNY - SUNY Cobleskill, who are subcontracting with the Bassett Center for Rural Community Health to work in the schools on the following items: review, evaluate and make recommendations on school wellness policies, reduce food marketing to students, improve the quality of foods available during the school day, improve access to physical activity before, during, and after the school day.
Community efforts focus on the adoption of Complete Streets policies and implementing changes in roadways during planned construction to make communities more walkable and healthy. Community strategies will also seek to improve access to healthy foods through local convenience stores and through working with organizations that serve foods to adopt food standards and procurement policies.
The grant’s goal is to implement multi-component evidence-based policies, place-based strategies, and promising practices to increase demand for and access to healthy, affordable foods and opportunities for daily physical activity for all New Yorkers. The Obesity Prevention Center for Excellence (OPCE), led by JSI Research & Training Institute, Inc. (JSI) strengthens the CHSC Initiative’s collective impact by providing technical assistance, training, resources, and a network to collaborate.
Defining the Digital Divide: Implications for Improving Access to Care
This study will use a survey of patients, electronic medical records, and key informant interviews to investigate the contextual factors that influence a person’s ability or preference to engage with TeleHealth technologies, contributing to the understanding of TeleHealth inequity in a rural population.
TeleHealth has undergone an accelerated, widespread implementation since the start of the COVID-19 pandemic. However, recent research suggests that TeleHealth’s applicability may be limited for certain vulnerable populations, including those who live in rural, medically underserved communities. While broadband access is certainly a barrier to TeleHealth use, there are other important factors that influence a person’s ability or preference to use TeleHealth technologies.
With funding from the National Institute of Health Care and Management (NIHCM) Foundation, we are using patient surveys, analysis of electronic medical records, and key informant interviews to investigate the contextual factors that influence a person’s ability or preference to engage with TeleHealth technologies. Our purpose is to better understand the barriers to accessing TeleHealth by studying those who are not using TeleHealth in our rural area. We intend to use these findings to develop ways of surmounting these barriers and thereby influence local and regional practice and policy.