Shaping Core Health Messages: Rural, Low-Income Mothers Speak Through Participatory Action Research

ABSTRACT

Rural, low-income families are disproportionately impacted by health problems owing to structural barriers (e.g., transportation, health insurance coverage) and personal barriers (e.g., health literacy). This paper presents a Participatory Action Research (PAR) model of co-created Core Health Messages (CHMs) in the areas of dental health, food security, health insurance, and physical activity. The research project engaged a multi-disciplinary team of experts to design initial health messages; rural, low-income mothers to respond to, and co-create, health messages; and stakeholders who work with families to share their insights. Findings reveal the perceptions of mothers and community stakeholders regarding messages and channels of message dissemination. By using PAR, a learner engagement approach, the researchers intend to increase the likelihood that the CHMs are culturally appropriate and relevant to specific populations. The CHM-PAR model visually illustrates an interactive, iterative process of health message generation and testing. The paper concludes with implications for future research and outreach in a technological landscape where dissemination channels are dynamic. This paper provides a model for researchers and health educators to co-create messages in a desired format (e.g., length, voice, level of empathy, tone) preferred by their audiences and to examine dissemination methods that will best reach those audiences.

Acknowledgments

The authors gratefully acknowledge the assistance of Andrew Shepherd, research assistant, at the University of Massachusetts Amherst.

Notes

¹ Rural Families Speak (RFS), NC223 (1998–2003) and NC1011 (2003–2008), research was also supported in part by USDA/CSREES/NRICGP Grants 2001–35401-10215, 2002–35401-11591, and 2004–35401-14938. Participating states: California, Indiana, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New York, Ohio, and Oregon.

² Rural Families Speak about Health (RFSH), NC1171 (2008–2018), participating states: California, Hawaii, Illinois, Iowa, Kentucky, Massachusetts, Nebraska, New Hampshire, North Carolina, South Dakota, Washington, and Wyoming.

³ The 12 states were California, Hawaii, Illinois, Iowa, Kentucky, Massachusetts, Nebraska, New Hampshire, North Carolina, South Dakota, Tennessee, and Washington.

⁴ The UIC considers population size, urbanization, and access to larger communities and classifies US counties, county equivalents, and independent cities into different categories with higher numbers indicating more rural areas. The sample came from counties with codes 6–12, with 6 indicating “noncore adjacent to small metro area and contains a town of at least 2,500 residents” and 12 being “noncore adjacent to metro or micro area and does not contain a town of at least 2,500 residents” (ERS, 2016).

⁵ The income eligibility is identical to the criteria used for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

⁶ The 10 states were California, Illinois, Iowa, Kentucky, Louisiana, Massachusetts, Maryland, New Hampshire, Tennessee, and Washington.

⁷ The match between communication channel and CHM was made through consensus of the research team, in consultation with health communication professionals, as well as for reasons of practicality, e.g., one may be less likely to lose a laminated bookmark than a piece of paper.

⁸ The eight states were California, Iowa, Kentucky, Louisiana, Massachusetts, New Hampshire, Tennessee, and Washington.

⁹ The 10 states were California, Iowa, Illinois, Kentucky, Louisiana, Massachusetts, Maryland, New Hampshire, Tennessee, and Washington.

¹⁰ For a quick guide to craft messages based on this study, contact the corresponding author.

Additional information

Funding

Data for this paper came from two studies: (1) “Core Health Messages: A Strategy to Improve the Health and Well-Being of Rural, Low-Income Families” (CHM), grant number [2010-46100-2179], and (2) “Dissemination of Core Health Messages: Using Community Based Participatory Research to Strengthen the Health of Rural, Low-Income Families” (DCHM), grant number [2011-46100-3113]. Both were supported by the Rural Health and Safety Education Competitive Program of the USDA Cooperative State Research, Education and Extension Service, National Institute of Food and Agriculture.