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Date Available

4-23-2026

Year of Publication

2026

Document Type

Graduate Capstone Project

Degree Name

Master of Public Health (M.P.H.)

College

Public Health

Department/School/Program

Public Health

Faculty

Dr. Paula Arnett

Committee Member

Dr. Rachel Graham

Faculty

Dr. Martha Riddell

Abstract

Type 2 diabetes and obesity are major public health concerns in Appalachian Kentucky. Populations in this region experience much higher rates of chronic disease than the rest of the state, have limited access to preventive care, and ongoing economic challenges that affect health. Many rural counties face increased poverty, transportation challenges, and shortages of healthcare professionals, all of which contributed to poor health outcomes and reduced access to evidence-based prevention programs. As a result, there is a strong need for focused, feasible, community-based interventions that improve access to evidence-based prevention while addressing the social and economic factors influencing health in this region. The Appalachian Kentucky Rural Health Initiative is designed as a targeted pilot program implemented in a small number of the highest-need Appalachian Kentucky counties, with the goal of strengthening and coordinating existing prevention and community health resources rather than creating entirely new systems.

The proposed initiative centers on the CDC- recognized National Diabetes Prevention Program (DPP) as its primary intervention to reduce risk for type 2 diabetes and improve overall health. Community Health Workers (CHWs) will support DPP outreach, enrollment, retention, and follow-up with services delivered in trusted community settings. Existing CHW infrastructure, particularly the Kentucky Homeplace program, will serve as the foundation for outreach, care navigation, and referral support. Additional support, such as limited produce prescription resources and connections to food access and transportation services will be used when needed to address any barriers to DPP participation and completion. Together, this approach prioritizes diabetes prevention while addressing the social and logistical factors that influence participation and results.

Successful implementation of this initiative requires strong collaboration with several established partners. The Kentucky Department for Public Health (KDPH) will provide alignment with statewide chronic disease prevention priorities and guidance related to CHW and DPP implementation. Kentucky Homeplace will serve as a key implementation partner, using its established CHW workforce, community trust, and experience in helping people manage chronic diseases. The University of Kentucky College of Public Health will support program evaluation, data management, and ongoing analysis of outcomes. Local health departments, healthcare organizations, and cooperating Extension offices in participating counties will support referrals, education, and community-based delivery. Lastly, Shaping Our Appalachian Region (SOAR) will act as the initiative’s regional partner, facilitating communication, alignment, and shared knowledge or data across the pilot counties.

The Appalachian Kentucky Rural Health Initiative is expected to improve access to diabetes prevention services and improve engagement in preventive care within the participating pilot counties. Key outcomes include increased enrollment and completion of the National DPP, improved diet and physical activity behaviors, and reductions in diabetes risk among participants. By focusing on DPP delivery supported by CHWs embedded within existing systems in the region, the program aims to improve referral pathways between healthcare providers and community-based prevention services without duplicating existing efforts.

Aside from individual health outcomes, the program will improve the public health infrastructure that supports chronic disease prevention in rural communities. By improving coordination among healthcare providers, public health agencies, and established CHW programs, and by improving shared data and evaluation processes, the program strengthens long-term chronic disease prevention efforts. This focused pilot approach emphasizes prevention and early intervention while maintaining feasibility for rural communities.

The program will initially be funded through the Rural Health Transformation Fund (RHTF), which will support startup costs related to coordination, evaluation, and program implementation. Long-term sustainability of the initiative will be supported through a gradual move toward Medicare reimbursement for eligible CHW services and other preventive care activities. Additional funding opportunities, partnerships, and connecting the program with existing state and local public health efforts will help it continue. Embedding program activities within existing systems such as Kentucky Homeplace will improve feasibility and reduce the need to rely on grants long-term.

A thorough evaluation framework will guide program monitoring, performance measurement, and continuous improvement of the program. Evaluation activities will be done in partnership with the University of Kentucky College of Public Health and will include regular data collection through standardized systems such as REDCap and Diabetes Prevention Program reporting systems. Focusing the evaluation within a limited number of pilot counties will strengthen the data quality, implementation fidelity, and using findings to improve the program and guide potential future expansion.

Overall, the Appalachian Kentucky Rural Health Initiative represents a focused, collaborative pilot approach to addressing diabetes and obesity in Appalachian Kentucky. By focusing on a single evidence-based intervention, using established CHW infrastructure, and improving coordination instead of duplicating services, the initiative is in a good position to improve health outcomes while working within existing services in rural Appalachian communities.

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