“The concept map we developed through eXtension is empowering the community and has given more credibility and clarity to the collaborative efforts I am facilitating.” Grace Peterson
Peterson is an area nutrition agent with the Louisiana State University AgCenter, and in that role, she has delivered programs typical for nutrition specialists, but “I’ve always been interested in systems thinking. We’re trying to create a different system altogether, not just make changes within the system. We want to be community-driven,” Peterson says.
The goal is to create a Community Health Hub (CHH) – a one-stop shop for health screenings, health and nutrition education, exercise programs, mental health referrals, parenting support, cultural awareness – in fact, whatever it is that the local community determines it wants and needs.
“We sit in an economically suppressed area of Shreveport/Bossier City,” says Betty Johnson, director of St. Luke’s Mobile Medical Ministry, a 501C3 organization supported by the Episcopal diocese and eight churches of northwest Louisiana. According to Census data from 2015, 23.4% of residents there live in poverty. That figure is 32.4% for Black residents, 19.8% for Hispanic or Latino residents, and 38 % for American Indian residents. Low-income populations also suffer from poor health: The adult obesity rate in Caddo Parish is 27.8 percent. Louisiana’s infant mortality rate of 8.8 deaths per 1,000 live births is more than double the national average, and that includes the population with which Peterson and Johnson work.
In March, the CHH working group coordinated a Community Health Connections event at Bernstein Development, Inc., a non-profit organization associated with Paradise Baptist Church in Shreveport. Of the 104 participants, 101 were African-American. The event highlighted health-related resources and services and offered participants a chance to discuss health concerns in a relaxed environment.
“Traditionally, when you’re trying to make progress with educational programming, you focus on delivering better programs, getting more funding, and doing a better job of communication, but the CHH needs more than that” Peterson says. “The challenge is changing the model from ‘We’re the healthcare experts here to give you these programs and these resources to ‘fix you’ to having the community itself define its needs and give leadership to change efforts,” Johnson adds.
“One of the needs that surfaced that I had not considered is the importance of access to dental care and how that affects diet. Several people said they could not try our recipes because they could not chew vegetables unless they were cooked to be very soft,” Peterson says.
Peterson, Johnson, and co-collaborator Cookie Coleman got a new tool to assist them in their change efforts through the eXtension Diversity and Inclusion designathon in February 2017. They were introduced to concept mapping, a visual way to display all the components of a system, the roles of various players, and the relationships between the parts. (See the CHH concept map below.) After working on the concept map in Cincinnati, they brought their ideas back to CHH leadership and planning groups. They found the tool extremely helpful in seeing the big picture and in explaining the process to local participants. For example, the CHH team has been successful in involving local leaders, such as “the matriarchal figure on the block that everyone goes to for advice” in the planning.
(See larger version WGTconceptmap)
“We have great players at the table,” says Peterson, including students and faculty from the LSU Health medical school and school of allied health, Southern University, the Food Bank of Northwest Louisiana, community health clinics, the Community Foundation of North Louisiana, and others. One outcome is that LSU faculty are involving students early in their school careers in the process to interact with future patients and practice communication skills. Fifty physical therapy and occupational therapy students were part of the March event on a food pantry pick-up day. “It reignited my fire to assist in the community,” said one student.
“We’re changing the model from ‘we’re here to fix you,’ to ‘what is it that you want and need’ and then providing programs and resources to succeed. It’s changing the way we work.”
Having the concept map as a tool has helped the CHH team entice new collaborators and potential collaborators. For example, an employee from the Louisiana Department of Health, Office of Public Health is now on board, so the CHH will reach out to young pregnant women and other young adults in addition to the older food pantry clientele. A second Community Health Connections event is scheduled in October at the Bernstein site. Peterson says several programs already identified to meet local needs will be ready for delivery following the event, including “Reading your Medicine Bottle,” “Dining with Diabetes,” and “Line Dancing for Exercise and Health.”
Working within the community rather than top-down “is slow,” Johnson says. “It takes a lot of conversation. People want to know, ‘How much of my time and my life are you asking me to give?’” Peterson agrees that this relationship-based approach is challenging, but the concept map is empowering the community and has assisted her in her leadership role. “I’ve been a leader in the CHH initiative from the beginning, but the concept map has given more credibility and clarity to the collaborative efforts I am facilitating,” she says.
While much work remains to be done, “We’re on the right track,” Peterson says. “This kind of community change and transformation, to be sustainable, must focus on policy, system, and environment (PSE) changes and not just programming. We need a process to manage and provide guidance in a constantly changing environment.”