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Community Coalitions Implementing and Sustaining Policy, Systems and Environment Strategies for Rural Health Equity.

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Rural community coalitions effectively addressed health disparities using policy, systems, and environment (PSE) changes. Policy, systems, and environment strategies showed higher sustainability than programmatic ones, proving crucial for long-term health equity.

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community coalitionshealth disparitieshealth equitypolicyrural healthsystem and environment (PSE) change

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Area of Science:

  • Public Health
  • Health Equity
  • Community Health

Background:

  • Rural communities face significant health disparities compared to urban areas.
  • Policy, Systems, and Environment (PSE) change approaches offer potential solutions for rural health inequities.
  • The Two Georgias Initiative aimed to address these disparities in rural Georgia.

Purpose of the Study:

  • To assess the variation in PSE and programmatic strategies implemented by rural coalitions.
  • To identify facilitators and barriers to strategy implementation in rural settings.
  • To evaluate the sustainability of PSE versus programmatic strategies.

Main Methods:

  • A mixed-methods analysis of data from 11 rural community coalitions over 5 years (2017-2022).
  • Tracking of 141 implemented strategies across 12 domains using a Community Change Tracking Tool.
  • Key informant interviews (n=121) to explore implementation facilitators and barriers.

Main Results:

  • Strategies were implemented across 12 domains, with food access, healthcare access, and healthy lifestyle education being most common.
  • Implemented strategies included policy (17.0%), systems (28.4%), environment (29.8%), and programmatic (24.8%) approaches.
  • Sustainability was significantly higher for PSE strategies (95.6%) compared to programmatic strategies (42.9%).

Conclusions:

  • PSE change approaches are vital for achieving sustainable community health equity in rural areas.
  • Partnerships and community buy-in are crucial for successful PSE implementation.
  • Addressing implementation barriers like staff turnover and resource limitations is essential for sustained impact.