One Community Health's Wellness Programs
- Need: Difficulties obtaining healthcare access to treat diabetes and obesity for low-income and Spanish-speaking residents of Oregon and Washington's Columbia River Gorge area.
- Intervention: A local healthcare facility developed wellness programs using bilingual community health workers to provide education and support that improves diets, physical activity, and teaches stress management.
- Results: Many participants in the wellness programs have maintained or lost weight and have seen reductions in their cholesterol levels, blood pressure, and blood sugar levels. Vegetable vouchers, cooking classes, and budgeting education has also helped patients afford healthy food.
The Columbia River Gorge
encompasses Hood River and Wasco Counties in Oregon, and
Klickitat and Skamania Counties in Washington. Famous for
its orchards, the Gorge's fruit industry is dependent on
its seasonal and migrant farmworkers, a majority of them
having Hispanic ancestry.
One of the Gorge's main health concerns is obesity.
Nearly two-thirds of Oregon's population is considered
obese, with Hispanics ranking higher in obesity than
non-Hispanics. Hood River and Wasco Counties exceed the
state's average in heart and cerebrovascular disease, and
death rates stemming from stroke are 20% above the
national average. Klickitat and Skamania have blood
pressure and cholesterol levels that are higher than the
rest of the state.
In response to the need for local culturally-relevant
healthcare services, One Community
Health (OCH) started several wellness services that
promote good health through activities like education,
screenings, healthy eating, chronic disease
The Steps to Wellness/Pasos Hacía Salud course was
originally developed with funds from a
2006-2009 Federal Office of Rural Health Policy (FORHP)
Rural Health Care Services Outreach grant to reduce
diabetes and teach weight management among the Gorge's
Spanish-speaking and low-income population. Through funds
2012-2015 Federal Office of Rural Health Policy Rural
Health Care Services Outreach grant, the program has
grown to address hypertension, hypercholesterolemia, and
Ongoing financial support has been provided through an
additional grant from
Providence Hood River Medical Hospital and general
budgetary funding from One Community
Several organizations helped to shape Steps to
Wellness/Pasos Hacía Salud, including:
Below are the current services
offered by One Community Health:
A 12-week Steps
to Wellness/Pasos Hacía Salud course
teaches stress reduction, physical fitness, and healthy
nutrition through self-directed action steps. A team of
Community Health Workers teach lessons encompassing
control and prevention of 4 main chronic diseases:
diabetes, hypercholesterolemia, hypertension,
hyperlipidemia, and obesity. Partnering with The Next Door, Inc.,
this course is offered at an affordable price.
Salud Chronic Disease Management is
offered to OCH patients struggling with hypertension,
diabetes, and obesity. Providers at OCH refer patients
to this program where CHWs and RNs work alongside the
patient. Individualized action plans are created to
help the patient carry out stress reduction techniques,
physical activity recommendations, and healthy
- CHWs lead an annual Farmworker
Outreach program during orchard harvest.
Educational presentations on weight management and
diabetes prevention are taught in Spanish. Food donated
by the community is distributed, and screenings are
offered. Participants are referred to OCH if more
specific care is needed.
- The Perinatal Program operates
within OCH by provider-referral for expectant mothers.
Perinatal CHWs provide comprehensive education and
support throughout enrolled patients' pregnancies and
postpartum periods. The expectant mothers and perinatal
CHWs work together to create plans for prenatal education
visits, ultrasounds, lab work, doctor's visits, and
follow-up care after delivery.
- One Community Health is a distribution site for the
Rx Program. In partnership with the
Gorge Grown Food
Network, the program offers monthly vouchers for
patients who screen positive for food insecurity. A CHW
offers one-on-one educational visits and community
cooking classes to these patients. The aim of these
classes is to empower patients to shop for healthy
foods on a limited budget and increase their cooking
skills while sharing a healthy meal with other
- Through the Reach out and Read
Program, each child visiting for a
well-child checkup are given an age-appropriate book to
take home. Parents are encouraged by healthcare staff to
read it to their children. The purpose of this program is
to support reading skills and the interpersonal
connection that comes through reading together as a
Most participants in the programs have maintained or lost
weight and saw reductions in their cholesterol levels,
blood pressure, and blood sugar levels. Below are some
specific results from 2015.
- 104 participants completed the Steps to
Wellness/Pasos Hacía Salud program
- Over 1,500 patients had at least 1 care management
appointment with the Salud team
- Over 200 pregnant women received care management from
the perinatal team
- Several participants have created on-going support
groups and walking groups
- More than 2,200 families received vouchers for fresh
produce from the Veggie RX Program.
One Community Health is featured in RHIhub's
Care Coordination Toolkit Program Clearinghouse.
For more information on the OCH community health worker
Castañares, T., Volkmann, K. (2011). Clinical Community
Health Workers: Linchpin of the Medical Home.
Journal of Ambulatory Care Management.
34(3), 221-233. Article
Challenges in starting up the Steps to Wellness/Pasos
Hacía Salud program:
- There was little familiarity in the community with
CHWs, especially from the healthcare community who didn't
understand the role or how to work with them.
- Significant education and guidance was needed from
clinic staff for the CHWs to be prepared and effective.
- The original 15-week Steps to Wellness/Pasos Hacía
Salud curriculum was labor intensive, requiring a great
deal of commitment, time, energy, and resources.
- Bilingual CHWs were hard to find.
Challenges in operating wellness programs today:
- It is difficult to keep Steps to Wellness/Pasos Hacía
Salud affordable for participants.
- CHWs are stretched thin. Running Steps to
Wellness/Pasos Hacía Salud and Farmworker Outreach
programs pulls them away from providing care management
at OCH for Salud patients.
- Data collection and data analysis is necessary, yet
time intensive and costly. Database limitations also make
it difficult to report certain results. OCH has been
unsuccessful thus far in securing funding to conduct a
comprehensive research study of the Pasos curriculum.
Finding good CHWs is the base on which to build these
kinds of programs. A good CHW is one who knows the needs
of the community, is seen as a leader, personable,
well-respected, and well-known. Carefully assess their
characteristics to make the best matches for teaching
teams. Once you have strong leaders, the programs can be
built around their skills. Here are some additional steps
to consider in running your programs:
- Learn the needs of your community by conducting a
community needs assessment and taking surveys.
- Create contingency plans, establish processes, and
rehearse scenarios to prepare for a potential loss of key
- Ensure staff time is budgeted for required meetings
to reassess and adjust the program structure when needed.
- Look for local partners (social service agencies,
universities) to collaborate on outreach efforts. The
collective impact of organizations working together is
The Popular Education model was used for Steps
to Wellness/Pasos Hacía Salud. This teaching concept,
originated by Brazilian Paulo Freire, links education and
Community health workers
Farmers and farmworkers
Limited English proficient
Uninsured and underinsured
Wellness, health promotion, and disease prevention
June 1, 2015
Date updated or reviewed
October 20, 2017
Suggested citation: Rural Health Information Hub,
One Community Health's Wellness Programs [online]. Rural Health Information Hub. Available at:
[Accessed 9 December 2022]
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about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.