Consumer Self-Managed Use of Rural Healthcare Services

In addition to accessible environments, successful employment and community participation of rural Americans requires successful health management. In rural America, health management resources are more geographically dispersed and tend to be more limited, which makes managing complex health needs more difficult. One approach to improving healthcare access for rural Americans is to promote and facilitate the effective and efficient use of existing healthcare services.

Our Consumer Self-Managed Use of Rural Healthcare program addresses this need by delivering individually focused self-management programs to rural participants, incorporating selected Living Well with a Disability (LWD) material. Our LWD program has helped improve the health of rural residents with disabilities in 32 states. By combining our unique goal-setting approach with health education, LWD participants report health behavior improvement, better health outcomes and decreases in healthcare utilization, especially emergency room use. Although LWD has been and continues to be successful, the program does have some limitations. Living Well is a group centered intervention with scheduling and transportation challenges that are greater problems in rural areas, and Living Well’s self-management strategies are not coordinated with the participants’ available healthcare resources.

In light of LWD limitations, the one-on-one format of our Consumer Self-Managed Use of Rural Healthcare Services decreases the challenges of scheduling and transportation. In addition, the national intervention program, Self-Advocacy for Rural American Health (SARAH), focuses on utilizing strategies that are coordinated with the participants’ available healthcare resources; the program also addresses an individual’s specific challenges to accessing these resources.

We compared the results of SARAH, a community and healthcare resource focused program, to our control program Conscientious Living for Rural American Health (CLARA).  CLARA includes educational health content from LWD focusing on nutrition, physical activity, and self-management but does not address participants’ access to community and healthcare resources. The SARAH program was found to be associated with better long term maintenance of health behavior. Participants in SARAH showed fewer health problems related to secondary conditions and fewer days experiencing pain.

Links to Project Publications Available on UMScholarWorks:

A Guide for Creating a Community Resource Map

Personal Community Resource Mapping: Road Maps to Better Health

Rural Self-Management Support

Self Advocacy for Rural American Health

Quick Links: Health & Wellness

Current Projects

  • Ecological Decision Support for Health Promotion
    Many communities across rural America are far away from healthcare services. Rural residents with disabilities may not be able to get to those services to address their healthcare needs. This project will provide a consumer directed health program to people with disabilities in rural communities that allows them to follow their own needs and interests for health improvement. Participants will use tablet computers and work with local Centers for Independent Living in order to participate in the program.
  • Healthy Community Living
    Healthy Community Living is a project to develop a multi-media health promotion program to improve people’s health and wellbeing that provides support, health promotion, education and opportunities for people with disabilities to succeed in reaching personal goals. It includes two separate curricula that blend in-person program delivery with online social engagement and website materials.
  • Rural Access to Health Insurance and Health Care
    The Collaborative on Health Reform and Independent Living (CHRIL) is conducting a nation-wide survey to understand how changes in health care reimbursement strategies affects working-age people with disabilities in terms of access to health insurance, and associated health care and quality of life outcomes. RTC:Rural is partnering with CHRIL to increase the rural representation in the survey and to answer rural-specific questions about health care coverage, availability, and quality of life.
  • Building Networks to Expand Living Well Delivery
    Living Well with a Disability is an evidence-based, peer-led self-management program that helps participants to set and reach quality-of-life goals by developing a healthy lifestyle. RTC:Rural provides training and certification for Centers for Independent Living (CILs) to conduct the workshops. Due to COVID-19, we have transitioned to providing Living Well with CIL partners in online workshops to provide peer support and community resources for people with disabilities remotely.

Completed Projects

COMPLETED PROJECTS | 2014 - present

  • Resilience in Community Participation
    Employment, social support, health status and the environment influence a person’s ability to deal with difficult experiences. These factors also have an effect on whether or not someone participates in their community. This study will focus on rural resilience to learn more about how people deal with difficulties associated with having a disability even as they participate in the rural community.
  • Pain Interference Patterns
    Because many people with disabilities experience significant limitations in their ability to engage in community activities (e.g., shopping, entertainment, etc.), we wanted to know how pain and environmental conditions affected participation in community activities. To help answer this question, we asked people with disabilities to complete 4 surveys over 18 months about their pain levels, environmental barriers, and participation in daily activities. About one-third of these people also completed six surveys for day for 14 days using an electronic diary that asked similar questions. We found that as people experience more fatigue and pain, their community participation decreased.


  • Consumer Self-Managed Use of Rural Healthcare Services
    In rural America, health management resources are not as available as they are in urban areas which makes managing complex health needs more difficult. One way of improving health status for rural Americans with disabilities is to use existing healthcare services that serve rural communities to promote effective health-related self-management.
  • Nursing Home Emancipation
    Many people with disabilities are institutionalized in nursing homes when they could live independently. Nearly forty percent of nursing homes are located in rural communities with limited access to services, family and oversight. Centers for Independent Living (CILs) have worked to move people from nursing home facilities into independent living situations with great success. Few people, once they leave a nursing home, ever return.
  • Peer Support for Rural Mental Health
    People with disabilities have poor access to mental health services in rural areas, a gap that may be decreased through peer specialist services. Peer specialist providers offer a variety of services to people with disabilities and share similar experiences to those they are serving. They provide peer counseling, advocacy and can help in accessing resources. This project developed and offered a peer support training program to Centers for Independent Living staff and peers to help identify and provide support for mental health needs among CIL consumers. Results showed that people sought peer services when they experienced an increase in mental health symptoms which subsequently were reduced back to normal.
  • Peer Support for Secondary Mental Health Conditions
    When people with disabilities experience mental health symptoms, participation in community life can be reduced. This study surveyed people with disabilities in rural communities to see what kinds of mental health conditions they experience. Implementation of a peer specialist training curriculum for CIL staff and peers indicated that people experiencing elevated mental health symptoms presented for peer support. Subsequently, their symptom levels returned to normal.

COMPLETED PROJECTS | prior to 2008

  • Living Well with a Disability
    The Living Well with a Disability workshop is a ten-week evidence-based program designed to improve the health and wellness of people with disabilities. People who have taken the workshop report better health, lower medical costs and improved quality of life.
  • Nutrition
    Good nutrition can be facilitated and supported by organizing the home environment. This line of research describes methods for assessing the environment and the ways in which it promotes healthy eating.
  • Secondary Conditions
    Health problems that come as a result of having a disability, such as high blood pressure and weight gain, can limit people from participating in life activities. This project focused on these secondary health conditions and led to the development of the Living Well with a Disability program.

Products & Training

  • Living Well with a Disability Living Well with a Disability is a peer-led health promotion workshop that focuses on improved quality of life through the development of a healthy lifestyle. Training is available.

External Resources