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Arnold School of Public Health

Arnold School of Public Health researchers awarded $1.8 million across 3 projects from The Duke Endowment

June 25, 2019 | Erin Bluvas,

Members of the Arnold School’s Department of Health Promotion, Education, and Behavior (HPEB) as well as the new Arnold School of Public Health Community Health Worker Institute will lead three new projects with funding from The Duke Endowment. Tackling issues related to health care access, health literacy and building the capacity of community pharmacies, these projects have been funded with $550K to nearly $700K each—totaling more than $1.8 million to improve health in South Carolina and beyond. In addition to the three Arnold School-based projects, the College of Education’s Ali Brian will spearhead a similarly funded project focused on supporting positive trajectories of health for families of rural preschool children.

Community Health Worker Institute

Julie Smithwick, founder and former executive director of PASOs, will lead a project that builds on the Arnold School of Public Health Community Health Worker Institute she launched in March of this year. With initial funding from the BlueCross BlueShield of South Carolina Foundation, the Institute provides training and support for community health workers and the health and community organizations that employ and interact with these professionals.

“Community health workers work within their communities to connect individuals and families with resources, identify barriers, and provide solutions and ideas to improve the health and well-being of the entire community,” Smithwick says. “This model involves supporting leaders who are partnered with health and social service organizations, but who are more importantly rooted and vetted within the community itself.”

The Duke Endowment award will help further the Institute’s aims to provide entry-level training and field placement experience to community health workers and training for their supervisors. Smithwick and her team will also partner with the South Carolina Community Health Worker Association to recruit new community health workers and work with hospitals, health clinics, health departments and other organizations to develop and implement effective community health practices.

“The Duke Endowment grant will help support a series of return on investment studies conducted by the Arnold School’s Core for Applied Research and Evaluation, which will allow us to assess the integration of community health workers into various health care systems and the effectiveness of using the community health worker model in South Carolina to address the needs of disadvantaged populations,” Smithwick says. “This funding will also enable us to provide technical assistance and effective integration of the CHW model in clinics, hospitals and community organizations throughout the state utilizing nationally recognized best practices. When implemented correctly, the CHW model saves millions of dollars and improves the quality of care for underserved communities.”


Capacity-building in the Social Determinants of Health among Independent Community Pharmacies

Spencer Moore, associate professor of HPEB, will lead a project to build the capacity of independent South Carolina community pharmacies to intervene on issues related to the social determinants of health (e.g., chronic stress, social isolation, food insecurity). Moore will work with members of the South Carolina Community Pharmacy Enhanced Services Network (CPESN) as well as the United States National network to develop and implement a training program in key topic areas (i.e., chronic stress and psychosocial resiliency; social isolation; food insecurity, access, and diet; household environment and resources) among South Carolina community pharmacies. 

“Chronic diseases are the leading cause of death and disability worldwide with 60 percent of Americans having at least one chronic disease and 42 percent having two or more chronic diseases,” Moore says.  “Intervening on the social determinants of health, such as social isolation, chronic stress, and food insecurity, can have a tremendous impact on a person’s risk for multiple disease conditions.”  

Community pharmacies are often on the front line caring for people with complex health and social needs, particularly in rural areas. “By building the capacity of pharmacies to address the social determinants of health in their patients, our program is formalizing many of the activities that community pharmacies are already doing and leveraging their experiences, skills, and social trust that they have with community members to improve the health of our state’s most vulnerable residents,” Moore says.  “Our goal is to make intervening on the social determinants of health sustainable among community pharmacies, while bringing about meaningful improvements in the lives of community pharmacy patients.” 

This project represents a unique and innovative collaboration between public health and community pharmacy.  “I am excited about the opportunity to work closely with the South Carolina CPESN and its Luminaries Deborah Bowers and Brian Clark on an issue that network members identified as important to them and their patients,” says Moore.

Improving Health Literacy

Daniela Friedman, professor and chair of the HPEB department, will lead the third project, which focuses on enhancing quality of care through improved health literacy — the degree to which an individual has the capacity to obtain, communicate, process and understand basic health information and services to make appropriate health decisions. She and co-investigator HPEB professor Heather Brandt will work with an established team of academic, clinical, and community partners including adult literacy centers and the South Carolina Hospital Association to evaluate patient communication needs across South Carolina, increase awareness among staff and care team members of health literacy disparities, and encourage informed and engaging health care-related dialogue to improve patient understanding and active participation in their plan of care.

“Nationally, only 12 percent of U.S. adults have proficient health literacy. South Carolina has the 13th highest rate of functional illiteracy in the U.S. and poor health literacy rates placing communities at extremely high risk for poor health outcomes,” Friedman says. “This is extremely concerning because health literacy skills are a strong predictor of health status.”

Previous research has connected limited health literacy with higher health care costs and elevated morbidity and mortality rates as well as high hospital readmission rates, low perceived trust in the health care system, and poor self-care management and treatment outcomes.

“This project will be the first statewide systematic initiative to implement a health literacy initiative in hospital clinics,” Friedman says. “I look forward to working with our community and clinical partners on improving health literacy and patient-provider communication across our state.” 

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