Leadership program addresses health disparities in rural Kentucky



The 2017 CLIK graduation class and leaders: Front row (seated from left) Ashley Gibson, CLIK participant; Morgan Fowler, CLIK participant; Elisha Fisher, CLIK participant; Mary Alice Prater, CLIK participant. Back row (standing from left) Ernie Scott, Kentucky Office of Rural Health; Beth Bowling, UK Center of Excellence in Rural Health; Betsy Clemons, CLIK participant; Mayur Ramesh Shah, CLIK participant; Darlene Allen, CLIK participant; Sherrie Stidham, CLIK participant; Fran Feltner, UK Center of Excellence in Rural Health; and Nancy Schoenberg, UK Center for Clinical and Translational Science.

Of the 4,436,974 people living in Kentucky, 1,833,344 (about 41 percent) live in rural areas, according to the USDA-Economic Research Services (ERS). What does it mean to be a rural area? That isn’t always easy to answer.

Rural is an inexact term that can mean different things to different people, organizations and governments.  There are numerous federal and state-level definitions of rural that have been created over the years for various programs and regulatory needs. However, there are three federal government agencies whose definitions of what is rural are in widest use: the U.S. Census Bureau, the Office of Management and Budget and the Economic Research Service of the U.S. Department of Agriculture.

What’s Rural?

The Census Bureau’s classification of rural consists of all territory, population and housing units located outside of urbanized areas (UA) and urban clusters (UC). The Bureau’s definition is the only federal definition that applies the term rural in an official, statistical capacity, allowing it to be viewed as the official or default definition of rural.

An urbanized area (UA) has an urban nucleus of 50,000 or more people. Individual cities with a population of 50,000 may or may not be contained in these UAs.

An urban cluster (UC) also has a core as identified above with a total land area of less than two square miles and a population density of 1,000 persons per square mile.

The Bureau’s definition is the only federal definition that applies the term rural in an official, statistical capacity, allowing it to be viewed as the official or default definition of rural.

Definition Important

Rural definitions are very important for government functions related to rural policy making, regulation and program administration for the following reasons:

  • Each organi­zation selects the best definition that meets requirements for participation in their programs.
  • The definition is used to determine eligibility for Federal ru­ral grant programs.
  • Imple­mentation of programs and laws that govern rural areas requires that poli­cymakers, regulators, and administer­ing agencies stipulate how rural will be defined.
  • Also, research and data collection requires statistical consistency and accuracy, as well as validation, by researchers and government agencies.

Innovative Programs

Generally, residents of rural areas have worse health and health behaviors and greater barriers to care. Also, residents have lower odds of health insurance and higher odds of not being able to see a doctor because of costs.

Fortunately, there are many innovative programs around Kentucky addressing these health disparities and barriers to care. For example, Kentucky Homeplace was created as a community health worker initiative to address the lifestyle choices, inadequate health insurance and environmental factors that are believed to contribute to these diseases. From July 2001 to June 2016, over 152,262 rural residents have been served. Preventive health strategies, screenings, educational services and referrals are all offered at no charge to clients.

Also, the Healthy People: Healthy Communities initiative addresses chronic diseases, specifically stroke and heart disease, in rural south central Kentucky. This program has decreased the risk of stroke and heart disease among participants.

Another program, Community Leadership Institute of Kentucky (CLIK) is a four-week, no cost, intensive leadership development training program. It is offered through a partnership of the UK Center for Excellence in Rural Health, the UK Center for Clinical and Translational Science (CCTS) Community Engagement Program and the Kentucky Office of Rural Health. CCTS is federally funded with $20 million from the National Institutes of Health.

Reducing Health Disparities

Now in its third year, the overall goal of CLIK is to assist community leaders associated with organizations that engage and empower communities to reduce health disparities, leverage funding and learn how to use data to improve services and programs.

Why is this important? Because collaborations between academic centers and community leaders offer unique and potentially powerful opportunities to affect change and find solutions.

Nine participants were selected for the 2017 Institute through a competitive application process, with priority given to health, education and human service leaders from Appalachian Kentucky.

In addition, priority was given to applicants who propose projects addressed cancer prevention; reducing obesity and sedentary lifestyle; chronic disease (diabetes, cardiovascular disease) prevention or management; and substance abuse prevention and treatment.

Real World Applications

To successfully complete the Institute, participants are required to attend all training sessions, which are led by UK faculty and staff and community partners.

In designing their projects, participants must bring in real world projects to ensure that there is a real world deliverable that builds organizational and community capacity. Each participant’s organization receive a $2500 grant for their participation and completion of proposed project. See profiles on previous CLIK graduates and the impact of their designed programs below.

A few examples of current programs are:

  • A School-based Tobacco Cessation Program: An Alternative Approach to Disciplinary Action
  • Extending the Walking Path of the River Arts Greenway
  • Learning Lessons from Community Backpack Programs: Best Practices and Opportunities
  • Community Guided Focus Group: Disparities in Treatment for Breast Cancer


A closer look at two CLIK graduates


Brittany Martin from Hazard, Kentucky

Project: Confronting diabetes in Appalachia (2016)

In her role as the BSDC coordinator, Brittany Martin, hosted community screenings, planned board meetings and wrote a regular newsletter. She soon realized that irregular screenings, a lack of follow-up, and shortage of robust data inhibited diabetes prevention and care at both individual and community levels.

Martin focused on setting up more systematic screenings, instead of opportunistic screenings, and eventually set up a diabetes registry to keep track of participants.

Her goal was to determine whether regular community screenings and targeted follow-up can help to identify un-diagnosed cases, measurably improve health, and reduce the emotional and economic burden of diabetes through connection with local resources.

Currently, Martin is a volunteer coordinator at BSDC focusing her efforts on diabetic eye exams. She is also studying for her OAT (Optometry Admission Test), with plans to apply to optometry school at Pikeville University.

Benefits of CLIK: CLIK brought a whole new world of opportunity, and a new skill set including grant writing, public speaking, evidence-based interventions, data mining for research and data collection and analysis. Most important, CLIK taught her how to connect with community as an insider.



Kelli Thompson from Hazard, Ky

Project: A winter garden project at Appalachian schools (2014)

As project leader with the Kentucky Valley Education Cooperative (KVEC), Kelli Thompson organized winter gardens at K-12 public schools in Bell, Leslie and Pike counties. KVEC funded the first winter garden at Pikeville Elementary School in 2014 after students conducted a community problem-solving project that identified the need for fresh, affordable vegetables in the winter.  Thompson used the CLIK grant to expand the gardens into other schools in the area.

The project grew and took on a life of its own when students wanted to share their newfound knowledge with a local homeless shelter. Students encountered barriers at the shelter, such as low reading levels and lack of access to library books. They overcame barriers by posting gardening videos online, creating a book sharing program with local high school students, organizing a book drive and installing bookshelves.

Currently, Thompson is the gifted and talented coordinator at the Kentucky Valley Educational Cooperative and student agency lead at the Appalachian Renaissance Initiative (ARI), where she manages the budget and programs for Race to the Top, a grant from the U.S. Department of Education.

Benefits of CLIK: CLIK allowed her to learn how to collect specific data. And, monetarily, CLIK allowed her to expand this project by reaching out to other schools.  She learned how to establish a rigorous and testable design for her project, so that at the end of the day, she had empirical evidence through pre- and post-test data to promote her innovative project in Pikeville and beyond.





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