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Using Clinical and Community Guidelines to Improve the Health of Rural and Underserved Populations in Chronic Disease Self-Management and Falls Prevention


Host Institution
Texas A&M Health Science Center (previous center): Center for Community Health Development

Health Topics
Diabetes | Immigrant, refugee, and migrant health

Residents of the Brazos Valley in central Texas are at increased risk for chronic diseases (e.g., diabetes, obesity) and at increased risk for falling. However, rural communities often have insufficient resources to help residents manage their chronic conditions. Researchers have introduced four interventions into the Brazos Valley and throughout the state to determine the best ways to increase the reach of programs that can improve disease management practices, health, and quality of life.

Researchers used the Chronic Disease Self-Management Program (CDSMP), an evidence-based program developed by Stanford University, to help people with a chronic disease understand and control their symptoms. Workshops made up of six classes were held in community settings and were led by two community members who also have a chronic disease. Participants were taught coping techniques, physical activity, medication use, communication skills, nutrition, and other topics. Researchers found partners in each community to support CDSMP, held ongoing training for class leaders, and identified past participants to help market the program. The CDSMP reached more than 170 participants in the Brazos Valley (more than 650 people across Texas) by implementing the program in 5 of 6 counties in the valley. The program’s effect on health-related quality of life is currently being analyzed through measures such as self-reported pain, fatigue, days absent from normal social activities, and number of hospital visits.

To address diabetes management in particular, researchers created the Diabetes Education Kiosk, a touch-screen computer program. Researchers first placed the kiosks in health clinics in the Brazos Valley, and then put additional kiosks in a grocery store, pharmacy, and community arts center in Corpus Christi, Texas. From March 2010 through September 2010, the kiosks were used 4,000 times by more than 1,300 users. Facilities that received kiosks also received a quick-start guide and technical assistance. People with diabetes and their friends and family members used the kiosk, which had modules including recipe suggestions, goal-setting worksheets, lifestyle tips, children’s health, and medication information. From March 2010 through September 2010, voluntary survey data showed that of 216 kiosk users 73% found it easy to use, 89% would recommend it to someone with diabetes, 77% planned to use it again, and 88% believed the information provided would help them take better care of their diabetes. In the next phase of the project, researchers will gather data about how the kiosk affects users’ diabetes knowledge, self-management practices, nutrition, and physical activity.

Researchers partnered with the Texas Association of Area Agencies on Aging, an organization that provides health and social services for older adults, to evaluate the statewide dissemination of A Matter of Balance, a fall prevention program created by the MaineHealth organization. Participants attended eight group sessions that taught them to view falls as preventable, change their environment to reduce fall hazards, and engage in physical activity to increase their strength and balance. From 2006-2009, the program reached more than 3,000 participants across the state, including residents in 236 of 254 counties in Texas. Participants reported increased physically healthy days, increased confidence in preventing falls, fewer falls, and decreased number of days kept from usual activity. These findings are consistent with those of the original randomized clinical trial and the initial translational research study.

In 2008, researchers and partners also established the Brazos Valley Obesity Prevention Network, a community-led group that focuses on environmental strategies to reduce obesity. The network includes partnerships with organizations such as the United Way, the Brazos County Health Department, the Brazos Valley Community Action Agency, and statewide groups such as the Texas Health Institute. The partners have organized physical activity events, created walking areas in the community, and increased signage for safe walking and biking. They are also training youth to advocate for policy changes to create healthy community environments.

Researchers are compiling best practices to encourage and increase the use of these interventions in rural communities. Lessons learned include how to successfully blend interventions with host organizations’ missions, how to actively involve community members, and how to help build community infrastructure to support new programs. All four programs remain active, and researchers are using their observations and evaluations to continue to build community support to increase the use of chronic disease interventions in Brazos Valley and across the state.

Bolin JN, Ory MG, Wilson AD, Salge LE, Wilson M. Dissemination of a low-literacy diabetes education kiosk tool in south Texas to address diabetes health disparities. Texas Public Health Journal Winter 2011;63(1):12-5.

Ory MG, Smith ML, Wade A, Mounce C, Wilson A, Parrish R. Implementing and disseminating an evidence-based program to prevent falls in older adults, Texas, 2007-2009. Preventing Chronic Disease 2010;7(6). Available at
Research Setting
Medical or clinical site | Rural area
Race or Ethnicity
Black or African American | Hispanic or Latino
No specific focus
Age Group
No specific focus
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Principal Investigator
Kenneth McLeroy
Marcia G Ory

Project Identifier
Chronic Disease Self-Management - Core Project (2004-2009)

Funding Source
PRC Program

Project Status
Not active