For people with disabilities in rural communities, it can be hard to access health care. Lack of services, distance, or lack of transportation can be substantial barriers to receiving adequate health care and preventative health care. Self-management health practices could help reduce the need for acute-care medical services for those in rural areas.
To help address this, researchers at RTC:Rural have worked to develop a health promotion app called Health My Way. The app, which is meant to be used on a tablet, guides users through health promotion content derived from the Healthy Community Living program. The Health My Way app allows users to explore up to 22 content areas including topics such as Disability Identity, Goal Setting, Healthy Relationships, and Eating Well. Users are also matched with a health coach who meets with them either in person or via telephone to review the content of the program, as well as provide accountability and support.
“The app is great because it allows individuals to work through it at their own pace and on their own time,” said Ivie English, a PhD student in the Clinical Psychology Training program at the University of Montana (UM) and one of the project’s health coaches. “They [participants] also have free reign over the topic areas they choose to delve into. I think people tend to like that autonomy and feeling as though the content is catered to them.”
Health My Way is currently being piloted by participants in Montana, North Dakota, and Wisconsin. In Montana, health coaches are UM graduate students who do their coaching via scheduled telephone calls. Health coaches in North Dakota and Wisconsin are trained staff members from Centers for Independent Living (CILs), who meet one-on-one with participants.
Though the pilot phase will continue until June 2019, participants have already self-reported some improvements. “I had participants successfully pass college classes and introduce significantly more vegetables into their diet with the help of the app. Boom!” said Ari Silverman, one of the UM health coaches. Silverman is also a PhD student in the Clinical Psychology Training program.
“One of the participants I worked with told me that knowing I would call helped to motivate her, even though her goal was one she had set for herself,” shared Krys Standley, who is earning her master’s degree in Community Health and Prevention Sciences through UM’s Department of Health and Human Performance.
As part of learning how to be effective health coaches and becoming familiar with the program content, health coaches attend weekly webinars with research staff and CIL staff in North Dakota and Wisconsin. They review topics related to the program content, as well as health coaching specific topics such active listening, relationship and boundaries and stages of behavior change. The webinars also serve as a discussion forum for coaches to share success and challenges they experience with the app or the Health My Way program content.
“Perhaps more than anything, I learned about delivering services over the phone. This is really telehealth coaching, which feels much different from meeting folks in person,” English said. “It’s extremely rewarding because although you miss face-to-face time, most individuals participating would have a hard time making it to Missoula due to living in more rural, isolated communities and some individuals had physical limitations that would have prevented them. Coaching over the phone increases their access to health support services.”
As part of the pilot, Standley, who is in the last semester of her degree, will be conducting additional interviews with participants about their experience using the Health My Way app. “I am excited to have the opportunity to explore Health My Way in my thesis,” Standley said. “One of my research questions asks about a personal sense of meaning and hope, and if it help to motivate the health behavior changes people make.”
The Health My Way app is part of the Ecological Decision Support for Health Promotion project. The idea and content for the project and app came from two of RTC:Rural’s previous projects. The first, Living Well with a Disability (LWD), is a health-promotion program that helps participants set and reach quality-of-life goals by developing a healthy lifestyle. The LWD program especially aims to help participants manage secondary health conditions. LWD is a 10- to 12-week program facilitated by a trained workshop facilitator who leads weekly meetings for the group.
The second project, Consumer Self-Managed Use of Rural Healthcare Services (CASM), helped participants connect to available healthcare services in their communities. CASM used some of the goal-setting and health-management content from the LWD program and addressed how to overcome specific barriers to using those resources.