In Jefferson County Public Health (JCPH) jurisdiction, Washington State, we focused on co-creating new paths to health care and immunization access for low-income families in rural areas. We prioritized two key principles: building trust through participatory research and fostering collaboration to identify local solutions. The research process was energetic and reciprocal, and the results galvanizing.
In Jefferson County, previous Community Health Assessments focused on the urban area of Port Townsend with minimal input from the rural towns of South County. South County has lower routine immunization coverage than other areas of the county and was historically disconnected from the health department. This issue was compounded by health department staff turnover, meaning that those responsible for the assessment were new, not from Jefferson County, and had no connections with the local community. The health department was eager to do more to meet health needs outside of urban centers. We used community-based research to understand community needs and preferences and engage South County residents during the process. To begin, we observed vaccine sessions and conducted windshield surveys and interviews. These revealed a complex story. We found close-knit and self-reliant communities who were without many public services available in more populous or high-income communities. People in South County felt “forgotten.” Many people faced barriers accessing food, housing, water, sanitation, transportation, and finding work. Schools are extremely important for the community and social life, and there were lots of different perspectives on politics and on vaccines, but the one constant was people prioritizing co-existing as a community.
To validate and share our analysis findings, we hosted “data walks” in Brinnon and Quilcene, two communities in South County. Seven stations displayed key findings from the initial research phase for reflection and refinement. Community members armed with sticky notes and markers were invited to share their thoughts, ask questions and provide their own insights. These interactive sessions informed better programming and policies that addressed the strengths and needs of the communities and inspired individual and collective action among community partners. By developing a comprehensive list of who to invite, recruiting attendees through trusted intermediaries with community ties, and making events accessible by providing food, considering location and timing, and “closing the loop” with paper copies/electronic handouts as a follow-up, we were able to discover new key perspectives and unexpected findings. These included: challenges accessing care and receiving support for LGBTQ adolescents, those who are pregnant, and people with substance use disorder, as well as how little the local health care providers knew about each other and the services they provide.
We held co-creation workshops to co-develop solutions with community members, partners, and health department staff, proposing solutions such as:
- No-Brainers: Partner with schools and health care providers to share back to school reminders about health physicals and immunizations.
- Quick Wins: Develop a “one-stop-shop” online resource with comprehensive information about health care services in South Jefferson County, including clinic hours, location maps and appointment scheduling options.
- Long-Term Solutions: Expand mobile vaccination clinics and pop-up health and dental services in South County towns, and partner with local schools and community organizations to improve healthcare outreach and education.
Not all ideas made the cut for consideration. Challenging, low-impact projects were allocated a long stay space in the “parking lot.” Community members reported feeling more connected to JCPH and motivated to address the issues revealed during this project. They formed genuine relationships which have led to collaboration across government departments – the fire department, public transit, the local hospital system, and schools - to move forward. Some even took immediate action! Within a week of the data walks, the health department had helped a family arrange health insurance, “and that is changing a family’s life,” as one team member put it.
Windshield surveys laid the foundation to build partnerships between JCPH, South County communities and partners. Windshield surveys are a quick, cheap way to get a “feel” for a community and they can be adapted to community-based participatory research by inviting community participation. Accompanied by a community leader in each town, we spent two days immersed in stories about life in South County – Bingo nights, hidden waterfalls, neighborhood events, football games – and how these everyday events intersected with experiences accessing health care and immunization services. We saw the baseball field that the community came together and built after getting frustrated waiting for government funding. We saw the fire station people stop in at when they have a medical question and can’t get a doctor’s appointment. The windshield surveys also revealed challenges we would have never thought to look for. For instance, a lack of knowledge about local health care options. The community center manager did not know there was a public health clinic in town, and we could barely find it ourselves. These unexpected issues led the health department to change their plans in response to community needs, looking beyond immunization to fund an environmental and climate health assessment soon after.
For more information, read the report here: https://jeffersoncountypublichealth.org/1775/Community-Spotlights
VillageReach website - https://www.villagereach.org/project/wa-health-equity/