xt7hx34mpg8d https://exploreuk.uky.edu/dips/xt7hx34mpg8d/data/mets.xml Kentucky University of Kentucky. Center for Developmental Change 1968 Other contributors include Street, Paul. Photocopies. Unit 1, copy 2 is a photocopy issued by the clearinghouse for Federal Scientific and Technical Information. Report of a study by an interdisciplinary team of the University of Kentucky, performed under Contract 693 between the University of Kentucky Research Foundation and the Office of Economic Opportunity, 1965-68. Includes bibliographical references. Part of the Bert T. Combs Appalachian Collection. books  English  Contact the Special Collections Research Center for information regarding rights and use of this collection.  Community Action Program (U.S.) Economic assistance, Domestic--Kentucky--Knox county. Poor--Kentucky--Knox County Community Action in Appalachia: An Appraisal of the "War on Poverty" in a Rural Setting of Southeastern Kentucky, August 1968; Unit 12: The Health Education Program text Community Action in Appalachia: An Appraisal of the "War on Poverty" in a Rural Setting of Southeastern Kentucky, August 1968; Unit 12: The Health Education Program 1968 2016 true xt7hx34mpg8d section xt7hx34mpg8d ,       ».·  —. ,   _, ,  ~   ,  ,V4.    .1, 1    . _ __ A _   _ It __ I ___w_h__  __,_ _A_ ,'__   _ _ ,   ,>;  Q    
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COHMUNITYACTIONINAPPALACHIA I
An Appraisal of the 'Var on Poverty"
in n Rural Setting of Southeastern Kentucky
Q
l
(Report of e study by an interdisciplinary team of thc University
of Kentucky. performed under Contract 0693 between the University
of Kentucky Rerenrch Foundation and the Office of Economic
Opportunity, 1965-1968)
V ` UNIT 12
n
THE HEALTH EDUCATION PRGRAH
by
V Paul Street
4
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ABSTRACT
The Health Education Program, a part of the Knox County OEO
community action program, has, since it began in 1965, changed from
an almost purely educational operation into one additionally involved
with service. Whereas it was at first, in effect, restricted to such
activities as distributing posters and leaflets, showing health
movies, promoting and presenting discussions, conferences, or lectures
on health, and urging people generally to seek professional nedical
services, it now provides a mobile unit staffed with one or more
nurses who can administer services within the scope represented by
` the role of the public nurse.
The mobile unit, a clinic and laboratory in several respects--
_ with examination facilities, sterilizing and refrigerating equipment,
air conditioning and its own power plant--delivers services to remote
areas of a rural mountain county by scheduling regular appearances at
the various lé community centers scattered about the county. It is
operated in close cooperation with the county health office, reporting
its activities, for instance, with those of that office in monthly
records for the State Department of Health.
After some three years of operation——two with the mobile unit-·
the program has gained considerable acceptance among the Knox County ·
population. Samplings among leaders of the county as well as house-
holders generally provided evidence of approval, in terms of feelings
) 1

 Q
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2 1
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I
that health services in the county had improved since 1965-—ranging 5
from 82 percent among householders to 95.7 percent among leaders. A
4
The specific impacts of the Health Education Program are il- U
lusively intertwined with other forces representing both the OEO H
community action operations (adult education, home economics and home Y
improvement counseling, the Early Childhood Program with shots and é
physical checkups for youngsters, etc.; and there are others not l
connected with OEO). The task of sorting its influences from among l
k
the "congl0merate" was not accomplished in this study. [
Nevertheless, some impact--in some instances rather clearly Q
related to the OEO community action program if not directly to the E
t
Health phase--emerged as measurably significant. For instance, more
of the youth from areas served by the community action program (where
centers operated) responded correctly to questions of health informa-
tion than did those from other areas. County-wide, too, youth
E
reported more dental and medical checkups and more recent treatment
from a nurse, when questioned at Time 2, than they had at Time l
some li months earlier (all at significance < .05 level). -
Also, a question in the householder interview schedules, dealing
indirectly with the family planning emphasis in the program--asking _
people's opinions of the ideal number of children for a family--
had a response at Time 2 significantly reducing the number named at
Time l. _
In general, however, the public health operations in "bulk?
in Knox County appear not to have increased substantially, either

   3
i since the program began in 1965, or perhaps even since the mobile
% unit went into operation in August 1966. The combined outputs of both
the OEO and the county health office, routinely reported by the county
i health office monthly were analyzed for trends in four basic activities:
é` immunizations family planning conferences child health chechups, and
i chronic disease checks. Only in the second and fourth of these was
E there any discernible increase that might show a relationship to the
% coming of the mobile unit, and the variations were such that no con-
@ clusions could be made with assurance.
@V The cooperative relationship between the OEO and the county
i health programs appears to effect an efficient arrangement. It does
_n not, however, produce more trained personnel. Actually, ‘ •
Aj Health Education Program, since it apparently could pay more,
6 "pirated" two nurses from the county when the mobile unit was obtained.
d These have DOI been replaced--for such personnel is in short supply
I in Knox County. The effect is somewhat, therefore, a partial gig;
it placement of, rather than addition to the original health service
` program in the county--which may explain why the measurable “bulk"
of fundamental health services has not significantly increased since
‘ the "addition" of the OE0 health program.
)
is  H      u?§;?;>;r= ~* '

 · ACKNOWLEDGMENTS
Credit Ls duu Dr. Arthur S. Holmes and Miss Peggy Kcmncr and
tneir staffs for the generous hclp they gavc in pr0v1dLng thc informa-
tion compiled hcrc, but pnrticulnrly for their opennuss, forth-
rightness, candor. and patience with the "1nqu1sit0r."
*  
1
I
1

 —'.\ · ` ` *’· - . ., _ `V il"'?-V-—-`N--N--WHM >Hviiv ` H `H“`_`r`_r`A` Qsatsr >—_, ¤.;~,;;;, ,5,;‘Yg2;}_§;;;;;;;_.;,;,,;,_;;§;;,é;:{Qssezese.e[:.3;f3_,_:;;:r ·..¤?.·}=F  *="*     L1
, .e, r¤¥*!R»

   -
r) Health Examinations, and Screening Tests for Diabetes, Cancer. and
Heart Disease. Tabulations were made on records going back approxi-
mately a year before the program began and more than two years before
— the mobile unit was obtained, on the assumption that any significant
changes, indicated in quarter-by-quarter comparisons, could reasonably
be presumed to represent impacts. Table l interprets the results,
as do graphs l, 2, 3, and 4, which are based on Table l.
Table l and the graphs suggest the possibility of some increased
activity coincident with the mounting of the field·operations phase
of the program--the use of the mobile unit beginning in fall 1966.
l This possibility appears, however, in only the categories, Family and
Office Visits for Family Planning and Screening Tests for Chronic
Diseases. Even so, the data hardly justify any comfortable generaliza-
tion one way or the other.
The most obvious conclusion would be, of course, that the program
is ineffective, at least in two of the four major areas selected for
the tabulation. Visits to the mobile unit, conferences with staff,
and examination of diaries of the nurses who go with the mobile unit,
however, provide convincing evidence that the program is reaching into
outlying areas and serving people of poverty and of real health need.
Also, the opinions of Knox County people generally are supportive of
the program. Somehow, such service is not interpreted through the
` statistics--that is, in statistics which provide a baseline against
I which to measure. The change is in guality, more than guantitv, of
servicel V
  A

 *1
6
TABLE 1
PUBLIC HEALTH ACTIVITIES OF THE
KNOX COUNTY HEALTH OFFICE*
(Activities selected as relevant to Knox County 0EO—CAP Health Education
Program)
Field & Office Child Screening Tests for
Quarter lmmuniza- Visits for Health Diabetes, Cancer,
tions** Family Plan- Examina- Heart
n;ngw*+ ;;¤ns**** Disease*****
July-Sept. 1964 1,558 111 21 0
Oct.—Dec. 1964 2,655 128 467 493
Jan.-lmr. 1965 3,040 105 3 0
Apr.·June 1965 966 115 110 0
July-Sept. 1965 1,266 110 273 146
_ Oct.-Dec. 1965 3,810 117 209 7
Jan.-Mar. 1966 4,390 114 rr 628 2
Apr.-June 1966 1,896 90 S12 11
July-Sept. 1966 S70 116 615 696
Oct.-Dec. 1966 1,230 161 0 317
Jan.-Har. 1967 1.565 155 O 699
Apr.-June 1967 2.095 141 129 191
July-Sept. 1967 538 158 368 322
Oct.-Dec. 1967 l.0S5 87 O 938
Jan.-bur. 1968 1,351 147 O 32
*Both the OBO-CAP staff and the county Health Office report that there
are often delays in getting their reports together, that what is left out
one month is reported in the next. lt was for this reason that data were
grouped into quarters, rather than reported by months. Also, parts of the ·
program are by "campaigns." Diabetes testing, children°s vaccinations, etc.,
axe usually done in concerted drives--which explains the extreme variations
even the 3-month intervals did not adjust.
**1nc1udes item coded 103-007.
_ ***1nc1udes items coded 201-048-Dl-25; 202-049-D1-26; and 202-066-D2-18.
****Inc1udes items coded 22-101-E2-21; 222-102-E2-22; and 22-102-E2-23. _
*****1nc1udes items coded 313-155-H2-21; 323-156-H2-22; and 333-157-H2—23.

 4 5* 2}
  GRAPH I IIHUNIZATIONS REPORTED IN IHITHLY REPORTS  
g » ’ _ OF KNOX COUNTY HEALTH OFFICE BY QUARTERS lj}
  ‘ (July 1964-March 1968)  
g . 1562
g 4190  
1 6g!
1 ¥:§:§
_ 6; saw Y?
1 ii.
   
  RUHU IIIIMINIIIIIII   
  2655 IAIIHINIHIIII J    
1 1 _ ij;
` 2095 " {ii.
` 1  
  me H§___iII-;j—I1—§$ g 
6 1625 KZIIHIIIZHHI-XXIII  
1 m im 4—_ 5 66:6
1 966 iiilé-IHH AHIIH- 6;;
`S 870     : QE
1 .6 __ _H___II__I  
JUIY OCt· Jan. Apr. July Og:. Jan. Ap:. yuly Og;. Jan. APT- July Oc:. Ja¤·  
A“K· N¤v· Feb- Hay Aug. Nov. Feb. Hay Aug. Nov. Feb. Hay Aug. Nov. Feb. if};
S*;=P[- Dec. Har. June Sep:. De;. Har. June Sept. Dec. Har. June Sept. Dec- Mar.  
64 ·a4 ms -65 -65 -65 ·e.e. we *66 'sc '67 '67 'cv '67 '68 Q?
  Approximate Approximate  
‘ date program date mobile unit  
. Started. (GTBDC bgsgn operation--  
effective July 1.) August 1966. 5;:

   {JUL] L7\)••‘|E|.\.n LIUV]  
161  
, 1 153 11111111-lxiili 3
6 55 HHZHXIXXHEIZZK  
1 T
  IIIIIIIMIHMK  
li•7   `gg
    ____H___II_llK»     
  I   j_ _$3 ,;j·
      7; * ¤j'1 —* _ Y
m r gu 4;. 131113111  
     *  l _ Y1 iii
I Hg
» 5  
J 3 If;
90 A  
87 11;ii1;;11  
. July Oct. Jan. Apt. July Oct. Jan. Apr!. July Oct. Jan. Apr. July Oct. Jan.  
` Aug. [lov. Feb. Hay Aug. Nov. Feb. lhy Aug. Nov. Feb. Hay Aug. Nov. Feb.  
Sept. Dec. Dir. June Sept. Dec. Har. June Sept. Dec. hr. June Sept. Dec. Mar.  
_ *66 *64. *65 *65 *65 *65 *66 *66 *66 f66 *67 *67 *67 *67 *63 lij
g Apptcxinste date Apprcxuuate E1;
  program started. date nobile unit  
  (mnt effective b¢8¤¤ °P¢1’¤¤i°¤"  
= . ju], 1,) August 1966.  
1 .  
I : 1%
2 1%
1 2
.9 g
·  F
1   ·‘ ·. ·}\·:s·.»¢;,;1;.,.....1....,..   . ~ -;.;~¢.=:.»1;»»¤·w:»z¤2x»esa:m~1»z.».·¤·.J;»;1:¤1i=·"  2 ..  ‘ =·   ‘ ·¤ · `  ‘ " 1 ` ` " v _` _ U ` _ _ _ _ ` ` __ _>   _

 kt   K ”»r” M ”V.> " ` A ‘   [ '=?  
g GRAPH 3 CHILD HEALTH EXAHINATIONS REPORTED IN MONTHLY REPORTS
OF IOJOX COUNTY HEALTH OFFICE BY QUARTERS
` (July l96!•-March 1968)
. 812 V I
i n
. Q
   IILII Ak!IIII .
_ 615 __   1‘ - __`
I  
` I
  IIIIIH Il .
/+67 —-··-——;
  ll H I  
i 388 ‘ ·—r
, \D
* .
· l
273 'e   ., . ..-,,...1. ._,,,, 
' .
  H I A " ' · 1
209 .. --- .--   .. v.r.. _ - rrrr -1
A r I z '
129 ' ‘ Y
110 I I '  ` _”m"` jj- ZZ-  -__;§. ji Q] `YQYIJ
I » . \ i
. ' ' [ *
0 ¤—_.;  ___ . _ __ ¤.e-·,...-s wi:. ..-:¤.= .-...- .   ;;Z.;;;  
July Oct. Jan. Apr. July Oct. Jan. Apr. July Oct. Jan. Apr. July Oct. Jan.
  Aug. Nov. Feb. Hay Aug. Nov. Feb. May Aug. Nov. Feb. May Aug. Nev. F4-?;.
E Sept. Dec. Mat. June Sept. Dec. Mm:. June Sept. Dec. Hat. June Sept. Dec. Mar.
'6!• '6i• ‘65 '65 '65 '65 '66 '66 ‘66 '66 '67 '67 '67 '67 ‘68
‘ Approximate date Approximate
i program started. date mobile unit
(Grant effective began operation--
; July 1.) August 1966.

  
  { cmu 4 smuazum; mm ron nmmzs, mean, umm nxsmsz, REPORTED
  ; IN MONTHLY REPORTS OF KNOX COUNTY HEALTH OFFICE BY QUARTERS
g ¤ . (July 196:.-mm. ma)
‘ sas Q —-——
; ‘ N ; ’
  , Q \ \
` L T ‘ _ 1
g { 699 I ____
§ asa .
. O
        ANIII INI
_ 17 —···-·—·-—-··—-··—·····-—····-·-····—·v········" ·····"··‘_`
     HIII  III I  
z 4 ...7, I-I1 I_
:· 32
  L INI AI I
1} Z,  ·»‘:= =
r· I July 04;;, Jan. Apr. July Oct. Jan. API. July Oct. Jan. Apr, July 0;;;, _|(m_
’ € MB- N¤v· F¤b· May Aug. Nov- Feb. May. Aug. Nov. Feb, my Aug, NOW p,,b_
_ ` $¢P¥l· Dec· Mar- June Sept. Dec. Mar. June Sept. Dec. Mar. June Sept. Dec. Mar.
*66 *66 *65 *65 *65 *65 *66 *66 *66 *66 *67 *67 *67 '67 *6;;
Z Approximate dutc ApP!i'0>;€·G€¤EEEZi;f—,i€.§g;2;.;,sggavztasm-;,,»,; =J-;;gL,e_._,    ..; ¤.-at-., ~· : V- -· » ·.; ..,.. ~.-. . e. ,. r .   ·; _ _, _ r.,. .. V _,     . 

 12 Q
In effect it appears: i
1) That health services are being dclixered more directly to f
people of need--though there is no "yardstlck" by which to {
objectify what should be the extent and effect of the ser- 9
vices. n E
Z) That as of the date of this report the total impact upon V
the health needs of the county, as interpreted through
objective evidence of service units delivered, has not been
substantially increased by the addition of the CAP, except,
tentatively, in the area of counsel for family planning and
of screening tests for chronic diseases.
3) That instability in the program and delay in delivery of the
mobile unit and shifts in personnel have been obstacles to l
full delivery of impact of the program upon its target.
The Character of the Service
The mobile health unit has obviously made health services much
more readily available to people in remote areas of the county. _
(Also, CAP has made the "Scouts"--the "jeep"-type four-wheel drive Q
vehicles--available to those of low income who need services at the
local or other hospitals outside the county.) The unit has a schedule
for visiting all the CAP community centers, with the days of its I
visits posted and announced in advance. It has not restricted its E
visits, however, to centers alone. For instance, it has scheduled ` E
days to be stationed in the Artemus com unity, where no center exists l
 
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  ~ 13
` .) Table 2, based on monthly reports of the Health Education staff,
, interprets the pattern of activities with which in is involved. It
Z appears likely that whatever impact it has had will be found generally
_ diffused throughout the county. _
Y msu 2 `
  ACTIVITIES CF HOBILE HEALTH UNIT STAFF
· BY QUARTERS, BASED ON MONTHLY REPORTS ` ‘
` NOVEMBER 1966-MARCH 1968 - ‘ _
  I,m,,,,,,i_ Personal Family Rafe? Examina- uovie Persons
  Quarter zaucns Contacts Plan- pals tions. Viewers Receiving
6 § — Conf. ning Tests Vitamins
 L Nov._—Dec. 1966* 306 598 15 3 Q67 489 126
‘ Jan.—Feb. 1967** 185 570 11 10 /+68 673 1i»6 p
Apr.-June 1967 473 1,015 ie 5 602 301 200
July-Sept. 1967 353 1,373 6 £• 1,126 768 258
0ct.—Dec. 1967 ZA9 757*** 9 3 1,166 392*** 196***
Totals 1,566 3,312 A5 25 3,829 2,623 926 .
*October report not available.
**March report not available.
***October report incomplete.
Note: Figures above are based on monthly tabulations. This reporting
arrangement appears to have been changed, the reports since January 1. 1968
being in narrative diary form in which "counts" of activities are in many
instances not recorded. One suspects that the above tabulations lack
accuracy--but probably in the direction of under, rather than over,
reporting.

 lb '
Obviously, data presented in the table above provide no "baseline"
from which to appraise progress in the health services to the county--
though the starting point for such services delivered by the mobile
unit was obviously zero. The table does perhaps, however, provide a
basis for each to make his own judgment of a sort. U
Perhaps some "flavor" of the program emerges in the monthly . .
report by the Health Education Program director, quoted here to pro-
vide some view of the wide range of program activities. (lt may be A _
noted that, despite the shift in character of the program to include
services not purely educational, the activities do include very
considerable attention to education. Indeed, it appears likely that
_ much of the energy of the staff is given to promotion of health under-
standings and attitudes, and in actually persuading people of poverty
to make use of available health resources.
This fact suggests the futility of any effort toward objective
quantification of what may well be regarded as some of the greatest
values in the program. The objective data provided in this report
may well be viewed by many as missing the most important points of
value.
Note in the report quoted below that there is great variety in
what goes on in the program. that it is entangled with activities of A
many groups, that, of necessity, it makes adaptations to exigencies
of weather, local resources, personnel limitations, and emergency
demands. This report, quoted in its entirety, is for January 1968:

 j · is
j SUBJECT: Health Coordlnator's Report for January
_ The nutrition talk was given by Hester Neal in only
L4 two centers, Kay Jay and Jackson. This is a course
g of ten lessons suggested by Head Start Guidelines.
Q We hope that more centers will take advantage of this
Q nutrltlon course. I. also, explained to the center
§ directors that if they were going to use this course
$ that they should start thls month so that we would
§ not have to be teaching several different lessons in
§ one month. The talk was scheduled at Barbourville Center
§ but bad weather cancelled it once and illness cancelled
Q it the second time.
E
Zi The Good Grooming A-H Project is going well in several
"i centers: Kay Jay, Messer, Rosenwald, Jackson, Middle-
J fork, Grays, and Bsrbourville; all report good groups.
Two movies, one on teeth and one on dating, were shown
. ln all of the centers, by Sue. that could schedule them
* during the week they were here. They were not shown
. at Measer, Cannon, Wilton, and Bethel. The King and
1 Queen Contest has been put off untll March to allow
Q more time for the centers to get ready. . _
The Mobile Unit was hampered this month by bad weather.
Flat Lick and Fount cancelled, and then Rosenwald can-
§ celled but had a make up day the following week. The
film strip on breakfast was shown in most centers. At
Cannon and Kay Jay lt was not shown because lt was not ‘
V taken. At Mlddlefork it was not shown because of no
center building. Wilton said it was not shown because
t no one asked to see it. At Ketchen it was not shown -
no reason was given.
A Senior Cltlzen's Day was held at five centers: Messer,
Kay Jay, Jackson, Grove, and Barbourville. Jackson and
Kay Jay had 24 and 27 ln attendance, and even Grove re-
_ ported 23, so Senior Citizens must be enjoying themselves
The centers reported ha