Road Maps to Health

At the Conetoe Family Life Center, some students and graduates of the lay health advising curriculum, developed at ECU, pose with Ruth Little '14 (back row, center), assistant professor of public health, and Edgecombe County Health Director Karen LaChapelle '96 (on Little's left). Also pictured on the back row is the Rev. Richard Joyner, pastor of the CFLC congregation.

Road maps to health

By Amy Adams Ellis

It's fitting the Conetoe Family Life Center in rural Edgecombe County sits alongside the railroad tracks. This place is all about creating connections.

On a hot and humid afternoon, a couple of dozen people have gathered on the church grounds to connect with each other and compare notes about the passion they share: to see their communities become healthier.

Everyone here either has completed or is enrolled in a lay health-coaching course developed and refined by faculty members from East Carolina University's Brody School of Medicine and College of Nursing. Graduates of the 96-hour curriculum serve as volunteer health advisors in homes and churches of their underserved neighbors-statistically, some of the poorest, sickest people in eastern North Carolina.

"My health coach helped me a lot…with my weight, my blood pressure, my sugar…. I walk more than I used to walk…. They tried to get you whatever help you might need, whether it was diabetes or blood pressure or whatever…. The main thing, they care about you."

Data show the volunteer advisors are helping improve health outcomes for this marginalized segment of the population by targeting behaviors related to weight and nutrition, activity level, diabetes and blood pressure management, and access to care.

"Remember this is about incremental change," says Ruth Little '14, an assistant professor in the Department of Public Health at Brody, who's there with Edgecombe County Health Director Karen LaChapelle '96.

Little, an eastern North Carolina native and pastor's daughter, has spent years working with an interdisciplinary team-and about $1.5 million in grant funding-testing and tweaking the curriculum.

She's been helped along the way by churches, federally qualified health centers, health departments, community physicians and dentists, hospitals, community colleges and Access East, a not-for-profit corporation established by various community health partner organizations-including Brody and Vidant Medical Center-to improve health access and health outcomes for the East's most vulnerable population.

"You have to be willing to stick with someone even when they don't show change quickly," Little tells the group.

One woman testifies that smoked turkey necks are just as flavorful as ham hocks when it comes to seasoning collard greens. Another says her 5-year-old grandson has learned to compare the sugar content on nutrition labels of various foods.

As the women share secret ingredients and healthy alternatives to preparing food, Little says a not-so-secret ingredient-and this program's key to success-is simple: love.

"It's about authentically loving people," Little says. "It's showing people your heart, not just your knowledge. It's demonstrating compassion over a long period of time, being willing to go into peoples' homes and churches. It's taking the program to the patients and not the other way around."

Getting to the 'why'

Few of the lay health advisors had previous medical experience when they signed up for the training. But now they're working in health care settings, churches and community organizations under the guidance of licensed health care professionals, helping to educate, support and encourage patients who've been identified by various health agencies as needing special assistance to manage their chronic diseases.

They hold exercise and nutrition classes and health fairs. They're helping neighbors better understand health issues and how to partner more effectively with primary care providers. They're trained to go beyond the "what" to the "why" in explaining the importance of taking medications correctly and keeping doctors' appointments.

"Health coach's pleasant words…. It's a help to the soul, you know, pleasant words. That's the difference between the telemarketer and someone who's concerned about your well-being…putting extra pressure on you, versus somebody calling you concerned about your health…. That's good for the soul."

They call their mentees weekly, visit them monthly and accompany them to medical appointments. They help them set personal health goals and overcome barriers to care. They connect spiritual wellness to physical wellness, patients to providers, gaping needs to available resources.

Jasmine Dozier was trained as a health coach in 2013 for Community Care Plan of Eastern Carolina, a collaborative network of primary care physicians, care managers, hospitals, public health and social service agencies that aims to improve the health of eastern North Carolina's Medicaid population. Dozier coached 30 individuals for a year and now provides the services at her church. She says consistency is what makes the model work.

"Some of these people didn't have anyone calling to check on them before. But they got used to my voice," she says. "Knowing that people from their community are taking interest in them makes the difference. I gained their trust."

The project was born in 2007, when the North Carolina Office of Minority Health sponsored a faith-based lay diabetes education pilot in minority churches in Jones County, where Little had conducted pilot work as the county's health director. The pilot's success led the Kate B. Reynolds Charitable Trust and the N.C. Health and Wellness Trust Fund to invest $600,000 to expand the project into Edgecombe, Lenoir and Duplin counties, other eastern counties with severe chronic health issues.

Another KBR grant of nearly $764,000 funded a community health-coaching partnership in 2013 in the same counties between Access East, CCPEC and Little. It supported translating the curriculum for use in North Carolina Community Colleges, which approved the course last fall and offered the inaugural class at Edgecombe Community College.

To date, more than 75 health coaches have been trained, impacting nearly 1,000 people. And those coaches are making a difference.

"Until you walk in my shoes, you don't know what I'm going through…. It was that little push that she gave me to want to take my medicine…to better myself…so I can stay here longer for my kids."

Health data for 300 predominantly African-American individuals across three counties-half of whom had received coaching for a year-showed the coached group lost an average of 5 pounds, while those receiving no intervention gained an average of 2.5 pounds.

On average, coached participants lowered their systolic blood pressure by 4.5 points and their diastolic blood pressure by 2.25 points, while those in the control group experienced an increase of 12.5 points in systolic pressure and 4.06 in diastolic pressure.

They also reported fewer emergency department visits, fewer missed doctor's appointments, greater adherence to treatment plans and vital assistance with issues like housing, medication, transportation and Medicaid eligibility.

Rosa Steele

Rosa Joyner Steele, a toned, vivacious woman in boots and a straw hat, was the first lay health coach trained at Conetoe Family Life Center. She recalls one individual whose nutritional challenges hinged on their lack of a refrigerator. She connected them with a family who had one they didn't need.

"It's about being tenacious and going the extra mile," she says. "Asking them if they need a ride. Going with them to the doctor and asking embarrassing questions. Picking fresh vegetables and delivering them to their homes."

Steele helps maintain the enormous community garden on the church property

-a rainbow of corn, zucchini, tomatoes, blueberries and other produce. One of her goals is to connect local youth with seniors who can teach them how to can vegetables and make preserves.

Her cousin and pastor of the congregation, Richard Joyner, garnered national attention when he was named a CNN "Top Ten Hero of 2015" for his tireless efforts to address chronic disease in his community. Today he delivers a passionate pep talk, building his sermonette around words such as "mobility, accessibility, sustainability, credibility."

Partnerships with purpose

Faith-based health initiatives are nothing new, harking back to the parish nurses who have played integral roles in traditional Episcopal and Catholic congregations. But they've become a national trend, in minority and underserved populations especially, as public health leaders have increasingly recognized and leveraged the church's influence.

"Nondenominational churches are the fastest growing in eastern North Carolina and across the United States," Little says. "Our goal was to develop a curriculum that wasn't exclusive to one denomination or even to faith communities. Studies reveal that health coaches can be effective paraprofessional members of health care teams in churches as well as medical practices."

Next is expanding partnerships so outcomes can be measured in a broader population; growing into more counties and community colleges and offering the curriculum online; and continuing work to establish a state-recognized certification for coaches.

Meanwhile, in Conetoe, the little church by the railroad tracks will keep making connections that make its community healthier.

"We need this from a grassroots community basis more than any other county," says Joyner. "We need to teach people how to not just manage chronic diseases, but how to prevent them in the first place."

Thus, the county with one of the worst rates of chronic disease is leading the way to a healthier North Carolina. That may seem ironic to some, but not to Little.

"I think that's scriptural," she says.