Transcript of Episode 4: Public Health 101 Group Chat

with host David Richards [DR] and guests Dr. Bradi Granger [BG], Tawanna Jackson [TJ] and L'Tanya Gilchrist [LG].  
Listen to the audio

[DR] This week on the Healthy Communities Podcast we’re going to talk about health literacy and the importance of community health workers. I talked with Dr. Bradi Granger, Professor at the School of Nursing at Duke University and community health workers Tawanna Jackson and L’Tanya Gilchrist. We’ll see that what you don't know can actually probably hurt you.

[DR] Welcome to the Learning Network’s Healthy Communities Podcast; I am your host, David Richards from APHA. This is Episode 4: Public Health 101 Group Chat.


[BG] Okay, great. My name is Bradi Granger. I’m a nurse scientist at Duke University and I work at the School of Nursing as a faculty member in our nursing program and then in the hospital, I also direct the nursing research program at Duke University Hospital in the heart center. That’s how I came to L’Tanya and Tawanna, and this initiative around helping our community becomes healthier through working with people on managing their own chronic illness. 

[TJ] I’m Tawanna Jackson. I’m a community health worker for the Transmission & 10 Initiative. My background is property management.

[LG] My name is L’Tanya Gilchrist. I’m a community health worker with the Chronic Care Initiative. I became a community health worker about four years ago at the Durham County Department of Public Health and I love what I do. I first started being a community health worker in church and did not know that was my title. With me being there, I asked one Sunday, “How many people here,” they’re about 80 people in the congregation. I asked, “How many people here have diabetes or know someone with diabetes?” And about 24 people stood up in the congregation. I know that health is a big deal in the churches and I can go on and on about it. I think I’m going to stop right here because I’m sure you have other questions. 

[DR] This is perfect. I want to capture all of it, so thank you L’Tanya. That’s actually a good segue, tell me about your community. Where was this church? And what was it like? 

[LG] The church was started by my dad. It was a family church and my brother is the pastor there now. My dad passed away in 2002 of complications of diabetes. I know that where our church is, there is a high concentration of diabetics that live in that area. It gave me a passion and compassion for people that have health literacy issues and that have trouble speaking up for themselves.

[DR] You sort of touched on the health literacy. I think it’s a more fascinating topic that doesn’t get talked enough about in terms of community health workers, but before we jump into health literacy, I briefly want to talk about how bad it is. You said 24 people in your church alone. I think in the background materials, I read that about 22,000 have diabetes, 35 percent suffer from cardiovascular disease. Bradi, can you talk about a general overview of the county?

[BG] Sure. I think that there were a lot of issues in the beginning that we identified because of the burden of illness in the county. One of the things that we dispersed was to look at the county from a geospatial mapping perspective and try to break it down, the whole county, into the areas of highest burden of illness. We’re able to use publically available data and look at the census and the distribution of illness across the county. That’s how we selected specific neighborhoods with a very high burden of illness to focus the effort of the community health workers. I was going to see if Tawanna wanted to talk about her area. 

[DR] I did want to turn to Tawanna. With your background in property management, you probably have a very good idea of what the neighborhoods are like. Do you want to share your background of knowing the neighborhoods and where are the greatest problem areas? Which neighborhoods and what are you finding in those neighborhoods? 

[TJ] You’re right. I do know the neighborhoods pretty well. Basically, what I do is to build the relationships with the people. The more outreach work that we do over there, which is canvassing and knocking on doors, the more we show up, we say we’re going to do certain things, and the more events that we have, and the more resources that I have to give out, the more receptive they are to me. The majority of the people that I come across, they do have chronic illness, however, they don’t want to share with me what the chronic illness is, like I said, until I have that relationship with them. What I’m noticing is that they’re disconnected. They’re not asking questions because they don’t know what questions to ask. They’re not going to their appointments because they can’t get there or their child got sick or something went on with housing or anything in the area that may have stopped them from going to the appointment. Then, that is why they’re dealing with any type of health issue. 

[DR] That was such an impactful thing that you just said is that they don’t know which questions to ask. On that note, let’s turn to health literacy. In the background materials, it said that about 30 percent of patients are health illiterate. Do you want to explain what that means to you and what that means to your project? 

[TJ] Okay. Health illiteracy means to me is that a person goes to a doctor’s appointment, and the doctor is telling them, “You have X, Y and Z.” and here’s what you need to do to maintain it and you give them a couple minutes. That person is listening, but they don’t understand anything. I’m not going to say every single time, but they’ll go home and not do anything until they get really sick. 

[LG] And David, that’s basically it. When they come home with the white sheet of paper that the doctor gives them from the visit, what we find is that a lot of people that have literacy issues can’t read the information. As community health workers, we take the time to show them. Then even how to fill in medicine boxes and making sure they know how to put the right medicine in for the day. And making sure that their medicines bottles are current because we’ve had situations where people have had expired medications.

[BG] I think to reinforce what Tawanna and L’Tanya have said, we study this in patients at the hospital in Durham County and we know that at Duke about 33 percent of our patients are lower than a third grade reading level for health literacy, meaning that they may be able to read, but even so, the health information that we’re asking is too much and it’s not easy to interpret that. I think one of the things that the community health workers have been so effective at doing is that interpretation. 

[DR] I want to turn to the credentialing program and how you became community health workers. 

[TJ] So for credentialing, we have taken a community health worker class at Durham Tech. It was a six week, twice a week course. The class itself was amazing because it gave a lot of the background of the community health worker and everything basically that needs to be done in your role. 

[LG] We do diabetes self-management classes. We’ve also done healthy homes certifications and mental health first aide, basically everything that we need. 

[DR] That’s fantastic. It sounds like both of you have been putting a lot of work into the education side, but what have you noticed, how does the community respond? 

[LG] You’re right. That is the greatest part. For me, I can tell you that I am most thankful for that because when I think about people and how we mingle and socialize, it’s important for people in the community to see you. 

[TJ] Yeah, I agree. The connection is what allows us to get to the next step. When I show up to some of these events, I feel like I’m everywhere and that’s what they say to me, “I see you everywhere!” But the thing is I’m not just working an event, sometimes I’m a participant. I want them to see me do other things hands on not just coming around trying to see things like hey what do you need things like that. I think it’s a little bit hopeful when they see us come out and do certain things.

[LG] My ultimate goal is to help people be a person, come out of poverty, live a normal successful life, a realistic life. Where you can have the things and you can be your healthiest self. People need to see somebody like me who has a number of chronic diseases, but I choose to work, I choose to contribute to the economy of Durham, North Carolina, to show people that yes you can make it, you really can.

[DR] Thank you for sharing that. L’Tanya, I love what you said that change happens at the speed of trust. I thought that was very powerful. 

[BG] This is Bradi. I feel like one of the most important aspects of the role of the community health worker has been already addressed in the conversation of relationship and trust. Our main goal, which includes all the payment models like the value-based payment model and the pay-for-service model, the main objective from a healthcare perspective is to help people achieve their goals of care. One of those things and problems that we have right now are the physician, nurse, pharmacist perspective in the hospital, we tend to feel like we know what the goals of care should be, while the patient has different ideas or understanding or desires about what their goals actually are. The community health worker role, because of the trust and the relationship that you all have with people and because you understand their context of living and their families and their neighborhoods, there’s just a whole different level of ability to establish a relationship long enough to gain trust and help them express their goals of care. The patients’ goal and the goal of maybe the healthcare team can be maybe much more aligned. 

[DR] Definitely. Do you want to turn to the findings? What are you starting to see? Is this being successful? 

[BG] One of the things that have been a big success is the Hypertension Initiative. We’ve just know partnered with the health workers in this program in hypertension for patients with extremely high blood pressure who have sometimes failed to pick up medicines or have picked up the medicines but are not taking them correctly. Those were identified and contacted and brought into care at Lincoln. Of the 250 or so patients with blood pressure over 200 and pressure over 100, the goals have been reached to 200 of the 250, and the remaining ones are being serviced by the community health workers team and contacted as well. We’ve been able to reduce blood pressure successfully in the vast majority of this group with very high hypertension and a very high risk of stroke. The health outcomes of that have been felt already. 

[LG] I think Edith and I have been able to work with people that have needed meters to check their blood sugar. They have strips that they need. Our program has been very successful in doing that because there were a lot of people that didn’t have them or they couldn’t afford them like Tawanna was saying. For people with blood pressure problems, you have them monitors at home to keep up and check their blood sugar and what we would do is take them a meter or a monitor for blood pressure and then give them the sheets that they can put on the walls and they can also on the sheets, if their blood pressure was high, they can put on there that it was high because my children got on my nerves or my car broke down or can’t afford to fix this. You know there are certain triggers that people go through during the day or the week that cause their blood pressure to be elevated. I had a lady in today that was saying that a nurse was coming to see her today but she doesn’t want to take her blood pressure because somebody just upset me and I know that it’s high. I try to encourage her that that’s the time to check it during the levels are good because you don’t want them to think about that thing that happened and how it can affect your health overall. We try to keep people encouraged and help them reduce those barriers by connecting them to a resource to get what they need like a meter or a blood pressure monitor or a barometer or whatever they need. If they have asthma, a flow meter, or whatever. We connect them to resources to get those things and that’s what we do. 

[DR] That’s fascinating what you said about blood pressure and that one bad day can really spike that. What’s next for the community health workers? Are you going to try to expand that project or where is the focus to get more community health workers or making sure that the ones are getting credentials? Where is the next steps for that?

[TJ] All of the above.

[LG] It’s important to us that there are more people that are trying to do this job. It’s not a job, it’s what we love doing and making sure that we get credentials. We’re working hard for that to happen for us here in North Carolina because when you think about the city, it’s different from the rural area where people may not have access. They need community health workers in the rural areas. So, it’s very important.     

[BG] Yeah, I think that the way that we’re working toward the next steps growing the certification through using our policy advocates at the state level to push that through. I think, as you probably know, David, there are differences across the country in the certification process and availability of community health workers. One of the things that has helped us a lot has been the partnership with Durham Tech and the ability to have them as a partner and develop a program with standards that is a very tailored program with standards of qualification and criteria for your skill sets and then be able to demonstrate is what we’re doing through each of these projects that we’ve discussed to show how the impact the health and population.  


[DR] That’s the show this week! The show was produced by David Richards. Thank you to my guests Dr. Bradi Granger, Tawanna Jackson, L’Tanya Gilchrist and Edith Slack, and thank you all for listening. I’ll see you next time.